In this issue:

1. Affiliate Q&A
2. Feature Story
3. New ACHE Resources
4. Professional Pointers

1. Affiliate Q&A with Saqib I. Dara, MD

Saqib I. Dara, MD
Director, New Program Development
Consultant, Critical Care Medicine
Rahba Hospital–Johns Hopkins Medicine International
Abu Dhabi, United Arab Emirates

Q: Tell us briefly about your background in healthcare management.

A: I work as a consultant in critical-care medicine. I am a junior executive and have only recently ventured into management. It was many failed attempts at implementing change that led me to seek greater understanding of healthcare-delivery processes and how to manipulate them for improved outcomes. I have been studying through programs offered by ACHE online, and I plan to enroll in an MBA program later this summer.

Q: How did you arrive at your current position?

A: After management at our hospital was taken over by Johns Hopkins Medicine International, a process of expansion and re-engineering service lines tailored to the needs of the community was launched. An opportunity opened up to align my career objectives with the strategic goals of the organization. I was very fortunate to find a mentor in our chief medical officer who assigned me responsibilities as the director for new program development.

Q: What are your primary job responsibilities?

A: I work under the supervision of our chief medical officer in building projects and expanding new service lines according to the needs of our healthcare community. I also am assigned to administrative tasks at the discretion of the CMO. These duties include assignments related to projects in ethics, corporate quality, managing physician performance and continuing medical education, among others. This diversity allows me to gain in-depth exposure and insight into a broad range of management issues through interaction with senior-level executives.

Q: What is the biggest challenge you face in your current position?

A: My challenge is getting all stakeholders to agree to and implement what at times seem to be essential and required steps for change. It is this human side of change management that has been difficult to tame and master.

Q: What is the biggest reward?

A: To have happy customers at all steps in the newly-laid-out systems and processes is a tremendous accomplishment. The main customers are, of course, our patients, who put their trust and health in our hands. The satisfaction of a patient with the care delivered to him or her is the biggest reward.

Q: Briefly describe the overall healthcare atmosphere in the country in which you work.

A: The United Arab Emirates (U.A.E.) is a very dynamic society. The healthcare sector reflects the country's overall atmosphere in that it has witnessed robust growth in recent times. The healthcare market has been growing at a rate of 7–9%, and hospital-bed capacity is growing very rapidly. All this is happening with a simultaneous emphasis on access, quality and safety. In addition, an increasing number of hospitals are looking to gain accreditation from Joint Commission International.

A positive aspect of this growth has been the healthy discussion and interaction between the various players including payors, regulators and providers. We have to remember, however, that the U.A.E. is a young country and some of the systems and processes taken for granted in Western countries may sometimes not be fully mature. A lot of work is being done, and sometimes the pace of change feels a bit too fast. But we have to catch up.

Q: How do you see the field of healthcare management changing in the next five years?

A: I strongly believe that healthcare management has a very bright future. The healthcare field has been somewhat behind other industries in terms of growth in management and quality principles. But in the last decade there has been a strong emphasis in this direction, driven by the goals of providing high quality and low cost. Accomplishing this task will require a bigger and better-trained healthcare management work force.

Q: What advice can you offer for other international affiliates?

A: We need a forum in which all of us can come together to exchange ideas and expertise. We can learn a lot from the experiences and stories of each other. I think ACHE does an excellent job at this through international outreach. My own affiliation with ACHE has been very rewarding in terms of my professional and personal growth through education, relationships and associations. I would like to invite more active participation in ACHE from healthcare executives at all levels worldwide.

2. Globalization of Quality Care: Great Strides, Continuing Struggles

By Megan Downey

Quality methodologies used by healthcare organizations throughout the world have been the fastest to cross international boundaries. The Middle East in particular is experiencing a fast trend toward standardizing methodologies.

"It's no secret to anybody that the extent of medical errors is very high," says Zeina Koubar Natour, FACHE, director of Quality Management at Kingdom Hospital and Consulting Clinics in Riyadh, Saudi Arabia. "Soaring costs of healthcare—coupled with the emergence of national and international accreditation—all led to a significant development of interest in using quality methodologies."

Another factor that contributes to growth in quality measures is increased expectations of patients and their families, although this is less of a push in developing countries. The majority of healthcare organizations internationally are moving forward with a main target of improving quality, reducing cost and satisfying customers, says Natour.

But while quality measures are increasingly being adopted, it's still an uphill climb worldwide. Healthcare, in particular, has been slow to adopt quality measures for a number of reasons. Below, Natour provides five:

• The highly differentiated nature of healthcare services and resources
• A highly dispersed and disconnected continuum of care
• Lack of encouragement from funding systems
• Deficiencies in clinical education and training
• The inability to clearly define the quality of patient care

Some countries also have begun to develop their own national accreditation programs—a definite step in the right direction. But blindly adapting these measures could be problematic. "The national systems were mostly acquired from the international system with no real understanding of the local situation and its needs," Natour says. "The only basis that these systems were built on is the need to develop a national accreditation system with no look toward what areas should such a system consider more important than others, what priorities need to be set in place and what consequences need to be installed to give the system the credibility it needs."

Due diligence also should be conducted to make sure the resources to sustain these systems are in place, resulting in continued success. Healthcare organizations also should be transparent with problems that arise, rather than developing a blame-based policy, or worse, hiding the problems, as has been the case in some organizational cultures, Natour says.

Another struggle nationally and internationally is a lack of data to shape quality management systems. Several Persian Gulf countries are developing national data banks for quality measures, but "such attempts still lack the necessary infrastructure for ensuring reliability, continuity and orientation toward actions and improvements," Natour says.

As more data is collected, future accreditations and quality management efforts will become more systemized. Quality management practices will be based on statistics and the success of methodologies like Lean Six Sigma as they pertain to a particular region or national culture. In the future, it is hoped that healthcare will not only match other industries in the adoption of quality concepts but surpass them.

Zeina Koubar Natour, FACHE, has held multiple quality management positions throughout healthcare organizations in Lebanon and Saudi Arabia, and currently serves as the director of Quality Management at Kingdom Hospital and Consulting Clinics in Riyadh, Kingdom of Saudi Arabia. She received a B.S. in Environmental Health and a Master's of Public Health with a concentration in Health Services Administration from the American University of Beirut in Lebanon.

3. New ACHE Resources

Below are new, timely ACHE resources such as books, study courses and Web sites, to help you excel in your career:

Managing Stress and Preventing Burnout in the Healthcare Workplace
By Jonathon R. B. Halbesleben, PhD

Essential Techniques for Healthcare Managers
By Leigh W. Cellucci, PhD and Carla Wiggins, PhD

Understanding and Influencing Physician Behavior (Self-Study Course)

ACHE Social Responsibility Web Page

4. Professional Pointers

Make Communication Count

Don't be a coward. If there are things to say, we should all have the courage to say them in the bright light of scrutiny and candor, filtered with tact and kindness. Don't hide behind thinly-veiled good intentions or anonymity.

Be sure to consider all of the consequences of what is about to be said. There are times when your own agenda or personal issues get in the way of clear-headed thinking. The failure to think it through sometimes creates misunderstanding.

In these trying times, the last thing that is needed is more heavy-handed or unnecessary communication.

Here are some steps for better communication:

• Ask yourself: Is what I'm about to communicate REALLY any of my business?
• Be absolutely certain to separate what you think you know from what you really know.
• Be certain that what you are going to say adds value in some way.
• Communicate it in the most succinct and clear way possible.
• Give the person you are communicating with ample opportunity to respond and ask questions.
• Be kind

Adapted from "Are you courageous in your communication?", an article in the April 2009 e-newsletter RESULTS from The Staver Group. For more information, visit thestavergroup.com.

TELL-A-COLLEAGUE

Are you glad you joined ACHE? Why not Tell-a-Colleague? Use our Tell-a-Colleague button to send a quick e-mail to let them know about us. You’ll find this button on the home page of ache.org.

Ideas for Future Newsletters

We’d like to hear from you. If you have any suggestions for what to include in upcoming issues of this newsletter, please forward them to mdowney@ache.org.