Gulf Council States Cooperating through New Tech, Devices, and Evidence-based Medicine.
Gulf Council States By His Excellency Tawfik Khoja, MD, Director General, Executive Board Health Ministers' Council, Gulf Cooperation States
SAUDI ARABIA January 17, 2017
Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, UAE, and Yemen Cooperating through new Technology, Devices, and Evidence-based Medicine.
Yisrael Safeek: Welcome Your Excellency. Dr. Khoja, you contributed significantly toward prioritizing patient safety in your role as Director General, The Executive Board Health Ministers’ Council for Gulf Cooperation Council States (GCC). These member states are Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, the United Arab Emirates, and Yemen. You led the Middle East Patient Safety and Quality Initiative with the aim of improving and benchmarking healthcare quality, infection control, and patient safety in the region. You authored and co-authored of more than forty books and manuals, including Glossary of Patient Safety which is so invaluable, it is on The SafeCare Group’s website. You are an advisory to the WHO and has been awarded many local, regional and international awards and recognitions. In your 2011 paper, Toward excellence in Healthcare: A call for the Saudi Center for Health Excellence, you called for the establishment of The Saudi Center for Health Excellence. This culminated in the founding of the Comprehensive National Safety Enhancement Program and Saudi Center for Patients' Safety. What is the Saudi Center for Health Excellence (SCHE)?
Tawfik Khoja: The Saudi Center for Health Excellence, as you know, that evidence based guidance was shown to improve the process of care and clinical outcomes and to have a local adaptation of high quality evidence- based clinical practice guidelines, cost-effectiveness analysis, decision making, and public health guidance is a complicated process, it is really time consuming and needs a lot of significant expertise and resources. So if you look to the Saudi Hospitals and Healthcare Institutions in GCC countries, every healthcare facility is working alone in order to use the best guidelines for evidence based approach and there was a little bit of improper coordination between these institutions and there is a really wastage of resources. As you know that I am a chairperson of the Saudi Society of Evidence Based Healthcare, so we propose a workshop which was conducted 5 years ago in Saudi Arabia. Dr. Abdullah Alkhenizan and I proposed to the Ministry of Health as well as the Saudi Council for Health, the establishment of Saudi Center for Health Excellence. It should go in line with what have been developed in America, Canadian Agency for Drugs and Technologies in Health (CADTH) and The UK National Institute for Health and Clinical Excellence (NICE). Also, we proposed to the Ministry of Health, Saudi Arabia some vision around this center and it came out of our discussion as a vital recommendation from different institutions in the kingdom and other expertise from the international advisory group. We proposed four scope guidance -- First of all, technology appraisal and how to use new technology, devices, and new medicine, especially you know that we have different schools of medicine in the GCC states from different countries. Second the scope of work -- the clinical guidelines and evidence based clinical practice. Third, diagnostic procedures, and lastly is public health guidance especially with the emerging new pattern of diseases and other problems in the public health. In order to make sure that this Center of Excellence is working in the right direction with each strategy, we have sub strategies or objectives. The first one is the adaptation of high quality evidence- based clinical practice guidelines from around the globe. Second, to develop the tools for the dissemination and implementation of SCHE guidance all over the Kingdom of Saudi Arabia (KSA). Third is how to monitor the implementation of SCHE and fourth, how to conduct, inform and direct clinical research in the KSA. The Ministry of Health, Saudi Arabia responded to our call and established the Center of Excellence for evidence based medicine where all institutions and all concerned people should work together in order to develop a nationwide project and have proper development, implementation and monitoring tools all over of Saudi Arabia which is vast country, and to make sure that the quality of care and safety measures are obliged by such center of excellence. This is in short, what I can say about the Saudi Center for Health Excellence. YS: Commenting on the importance of the initiative, you said, “With the emergence of infectious diseases and growing healthcare expenditure, patient safety and quality is a major challenge & priority for KSA and the GCC.” Why? TK: I think this is a great question. This is really a question raised from time to time in KSA as well as in the GCC countries. I see many challenges and opportunities facing the Kingdom of Saudi Arabia’s state is due to the changing of the prevalence, pattern of diseases, and also the epidemiological transition growing of non-communicable diseases, more over the emerging and reemerging of infectious diseases which is like Corona and other disease coming up. Also, the problem of raising the expectation of the consumers and by the citizen of the GCC and KSA for quality of care. And above all of these is raising the cost and also raising the demands for healthcare. Unfortunately in the past -- the GCC countries - we looked at that issue of quality and safety from the perspective of providing the infrastructure, the building, offering the equipment and staff recruitment. But establishing good quality of care we faced with escalation of the problem related to infection control, medical error and other problems related to patient safety and also we are facing the issue of people that are not trusting the healthcare as it should be. So this -- the range of diseases and the emerging of technology and the emerging of variety of drugs, all of this make the situation very difficult for maintaining quality and safety, especially if we talk about corona virus problem which have been in Saudi Arabia for the last few years which led to more investment in this area and more cost burden was given to these areas. And if you look to the KSA and the GCC states, they are really in a position of attraction for different reasons; KSA where there is an influx of religious visits from different countries -- and a lot of people are staying for a while. So they bring with them their own disease and this needs a high surveillance system, supervision as well as coordination between the KSA, other countries and WHO for disease control. Also if you look at states like Dubai, Qatar and other they are areas of tourism, you see more than two million people are visiting GCC countries each year and not only that but they are in continuous change every year, they are unstable, also GCC states facing a situation which is threatening the health care that there are more than 10 countries in the Arab world having internal conflict, emergencies, and they are in wars. The southern part of Saudi Arabia, like Yemen, they have problem with infectious diseases: dengue fever, malaria and recently two cases of polio. So this is really a challenge to them to maintain good quality and to maintain the safety measures in the GCC countries, and moreover if you look to the implementation of infection control measures, some of the hospitals they are suffering. I should not forget the role of the private sector in healthcare provision in KSA and GCC states which is increasing. The technology oriented approach is escalated in the private sectors which need a special attention regarding monitoring the quality and the safety. Another thing that the healthcare system in the GCC rely heavily on expatriate and these people need to understand the national healthcare system in each country. In each year there is a great turnover, multicultural, and multi-language of human work force and you need to train them in a continuous basis from time to time, they need to be oriented about the system in the GCC because there is a variation in the standards and so we have different schools of healthcare in the GCC countries. This is again especially dealing with infectious diseases management and guideline to be used. It is again a major issue in quality and safety. And even that in the kingdom of Saudi Arabia and the GCC countries the issue of clinical audit, governance, accreditation, and evidence based practice is a new subject.
YS:You were involved with development of a system of accountability for medical errors in the KSA. Tell us how you went about doing it. TK: First of all, about the consequences for medical errors in Saudi Arabia and the GCC. If you see every day, we read about medical errors in the newspaper and listen to the TVs and the social media and every time I stay with my colleagues -- my relatives -- a question pointed to me, where are you -- where are the leaders of healthcare, where is the authority to overcome the problem of medical error. Our real problem is that getting doctors to admit they have committed a medical error which is the biggest challenge. And the consequences of such issue in the system is not yet going in the right direction. So you need to highlight on the importance of such subjects. For that we conduct a lot of in-depth analysis and situation analysis about the magnitude of medical errors and medication errors and we analyzed so many studies from different ministries of Health at GCC states. GCC countries see this as a matter of priority in building the trust with the consumers and their satisfaction as well as to improve the outcome indicators. We proposed in 2005 the vision forwards to our ministerial meeting, the resolution from our GCC ministerial annual meeting which was conducted in Kuwait, that we agreed upon to put medication errors, medical errors and infection control as the top three priority area for patient safety. It came out that the health care leaders pronounce their mission statement and policy: is to provide safe, effective, efficient and high quality preventive and curative healthcare services delivered by a high professional medical team to the community. We did many steps in order to make sure that accountability towards reducing medical errors as part of the safety movement and to put it as a major priority to the policy makers, healthcare providers and managers. So we advocate a lot of approaches and we disseminated guidelines, allocated resources to the healthcare institution in order to understand there is a problem and work together to overcome it. Moreover we raised the issue to our supreme council, were the Resolution on this matter was declared from the Supreme Council of the Cooperation Council for the Arab Gulf Countries in his Session (32), Riyadh, 19 – 20 December, 2011 as a political statement: “The Supreme Council… Having been informed with the Ministerial Council’s recommendation in its 121st Preparatory Session concerning what has been raised by their excellency the Ministers of Health in the Council States about accreditation of health facilities to raise quality level of health facilities, and improvement of the concept of quality and patient safety & safe health practice as well as improvement of the standard of health services provided to the citizens of the Council States to match their counterpart international standards.” Patients can also be harmed by poor communication between different health – care providers, or delays in receiving treatments. So we stress the importance of communication -- I mean we disseminate a lot of information to make sure that we have an open and clear communication about the problem and they should be part of the team and also to get the patient involved in this area and to engage people as part of our accountability also we conducted few studies on patient safety culture and situation analysis of medical errors in the hospitals. And we came out with a solid information and data. Then we developed a strategy for such a process in order to maintain reporting of medical error and malpractice as well as physician errors and to adopt proper measures to aid awareness of problems and activities to be implemented. Also we have total commitment from our Ministers of Health. The Ministry of Health in KSA implemented a helpline for members of the public to report medical errors and also we adopted the charter for patients’ rights and also we try all possible means through workshop, conferences and meetings to build up the culture blame free to make sure that errors are reported and should not be used against reporters, as well as to make sure that every member of the healthcare team is accountable and responsible for his/ her duties and the shared duties of others in Total Patient Integrated Comprehensive Management. So we build collective responsibility and accountability that patient safety is everyone mission: the healthcare team, the administrator and others are responsible – who are involve in patients care. Actually, patient safety embraces all healthcare disciplines and actors, requires a comprehensive multifaceted approach to identifying and managing actual potential risks to patient safety in individual services, and finding broad long- term solutions for the system as a whole. Second, there is a hierarchy of the strength of evidence for treatment decisions but the physician and the healthcare team must begin his / her choice with the highest available evidence (systematic reviews) from the hierarchy. The council did all possible means that our work should provide and monitor high quality evidence-based recommendations and on a continuous bases we disseminate them to our colleagues. And my job is with my colleague to summarize the main components of such evidence and try to disseminate and circulate to the targeted group, to the concerned people and to the ministries of health in GCC countries. Then, we adopted Hit Everywhere Never Miss One approaches to all targeted people involved in healthcare provision, workshops and conferences communities, as well as brain storming in order to manage the change in the community of healthcare profession as well as we ask all healthcare commission specialties to include in the curricula of their specialties evidence- based medicine. So we have in the GCC the Saudi, the Omani, the Kuwaiti, the Emirates and the Yemen commissions for health specialties, give higher degree for post graduate students. So we wrote to them about the importance of uptake of evidence based medicine as an important component in post graduate education. For this a GCC ministerial resolution was announced as follow: “Address all concerned authorities in medical/ health education at the GCC countries to include the patient safety and HC quality concepts, notably the WHO Patient Safety Curriculum, within the educational curricula at all levels and qualification of health leaders in view of the increasing concern of patient safety as one of the patient rights.” Moreover from time to time, we informed the community through the press, the social media and through the other facilities of education and communication about the importance of seeking the best evidence for their treatments. So by this, we tried to use as many tools in order to uptake the evidence based medicine guidelines and recommendations as a way of life in health care provision. YS:Can you tell us about the process of developing and adopting high quality evidence based clinical guideline? TK: I’ll try to summarize. I was the chairperson of many committees for developing the guidelines in the KSA as well as a coordinator of some guidelines, especially for chronic diseases like diabetes and hypertension, coronary artery disease and others. We understand that evidence based guidelines needs a lot of time, resources, expertise and also it needs special training and education and choosing the right people who are able to do the job right in proper time and loyal to this issue. So we adopted 11 steps and I’ll just go quickly on them that I would come back to the issue of transparency and others. First, we identify the clinical area to promote best practice, For example, diabetes or hypertension. Second, we establish an interdisciplinary clinical guideline evaluation group or formulating a national committee from different sectors including the private sector and different medical specialties to the subject matter. I mean we include sometimes family physicians, the social work to be member of the committee in order to discuss this project method in comprehensive, integrated ways. We should have for each guideline committee their own goals and objectives. Third, having an agreed upon overall of framework, the goals and objectives. Fourth , we as guideline evaluating committee we used the World Health Organization (WHO) tool which is called the Appraisal of Guideline Research and Evaluation (AGREE) instrument. It is endorsed by the WHO, the Council of Europe for the more than 15 years. It is a strong instrument to evaluate the guidelines, and it was designed to assess the process of guideline development and the extent to which the process is reported. Fifth, we divide the task according to the specialization, experience and knowledge and one interest. Sixth, search for the best available guidelines or retrieved all related ones using the PICO approach (Population, Intervention, Context and Outcome of Interest), and try to retrieve most of the guidelines related to the subject. Seventh, we have a rigorous assessment over the guidelines with a comprehensive approach and everyone is alone and then we have a meeting together in order to pinpoint which is the best analysis, where the weakness point and then we should agree on the best available evidence for such guidance or recommendation. Eighth, then it becomes the next stage which is we adopt or adapt. But we notice that the adoption of the abroad guideline is a difficult issue and it does not fit some of the times our local situations. So we do adaptation of the guidelines to tailor to our needs of the GCC counties. But we make sure that the recommendations which was modified to tailor our needs should not to be out of the content and should be on evidence- based approach. Ninth, after reviewing the recommendations, the guidelines which is available and supported by our needs based on evidence, we seek external review of the proposed guidelines. So we send the guideline to expertise people in the world, to the WHO to other organizations and sometimes to other centers of specialization and to ensure that these recommendations with our guideline does not taken out of the context or adapted inappropriately. Tenth, then we obtained official endorsement and adoption of the guideline by the Minister of Health. So we announced this adoption of the guidelines through his presence and sometimes we had a national symposium or workshop in order to make sure that we invited the concerned and targeted groups regarding this guideline in order to orient and engaged from the beginning. Then we developed a plan of action for dissemination and communication with the concerned people in order how to uptake and how to adopt these guideline in their daily work. Eleventh, the last point which is the review and revision which should be on a regular bases - this is a weak point in our system and we hope that the Healthcare Center for Excellence and the Ministry of Health should do their work in this on a regular basis to make sure that a deadline is revised, up to date as well as it is very consistent within evidence- based approach movement. So this is in short about the process of developing and adopting a high quality evidence - based clinical practice and guideline.
YS:Can you describe the transparency of the process? For example, did the doctors in the GCC countries get to see the guidelines as part of the adopting process to offer feedback? TK: Yes, thank you. This is again a very crucial point. So we ask some representatives from of the regions, districts and remote areas dealing or working in the subject matter, for example hypertension. As well as we engaged practitioners from different healthcare institutions, to come and to tell us about the visibility, the relevancy of the guidelines, the clarity, the validity and the applicability, all of these areas related to the guideline. It is very important to see how applicable this guideline is, how clear it is and also to have their input about the practical issue regarding the patient and what resources you need, what training they need. So this happened for many guidelines we developed but really this is hard work to make and it needs a lot of resources and a lot of commitment, but it make a lot of difference in the healthcare quality and safety business. We have formal feedback from them. Also we ask them their opinion in writing. In order to see the uptake of the new guideline we conducted a study before and after the implementation of such guideline and then we seek why it is not implemented, what are the difficulties and how can we bridge the gaps of such limitation. So there is really a good collaboration between the providers and the planners or the developer of the guidelines. But I think this area needs more attention because at the end, you need the guideline to be in practice. It is not only a textbook to be in the shelf, but it really should be visible and relevance, so it is not only to use the guideline, but also to make sure that the guideline will be a tool to improve quality and patient safety from the target audience and I remember an article I read in the RCGP journal long time ago, that adopting the guideline by the general practitioners in U.K. for bronchial asthma does not exceed more than 35%. Remember this is an international problem. So we need to engage clinician and other healthcare team in the development of the guideline and to make sure that their views was considered and their clinical experience is appreciated, and to make sure that concerns they are facing should be looked after in the guideline developments. YS:How did your team went about motivating and encouraging change in practice after they put the guideline in place? TK: The dissemination of the guidelines and the awareness has become part of daily work. How far we assure that this one is taken seriously and practiced. So we conduct as mission study for bronchial asthma and we faced some gaps – so had few meeting with the decision maker at the ministry of Health, we discuss with them how can we bridge the gap. I understand that there are 3 levels of people and they have different type of motivation. People who need to raise their awareness, people needing to raise their understanding, and lastly, people who need to act. So I think for any guideline, you cannot make all people to act on the guideline. So the first people -- you need to make sure people are aware about the guidelines and they should know that medicine should be on quality the component and the quality way should be through clinical practice guideline. So they are aware. So they have to be part of your game. They have to be part of your team and this helps to solidify within the community of healthcare provision that there is a guideline. Second is the understanding. So this is a group of people -- they need to understand the importance of guidelines and for doing this they need a special work and to have a deeper commitment from them more than the first people especially the one who are conducting the clinical work. Third the people who needs an action and they needs to change their behavior, to change their attitude and make sure that they adopt the product and the material and approaches offered by the guidelines. And these groups of people, the really need to have a special kind of workshop because they are the influencing people and the one who bring the change and the one who really -- equipped with the right skills, knowledge and understanding of the guidelines and also they will make achievement in real life. So it’s becoming really an attitude now in every institution in the GCC, for that people ask you what is your evidence and this is based from my communication with different target groups, also I should say that there is a lot of advocacy, mobilization of resources, try to have an incentives who will review – evidence- based guidelines, this enhance the process of implementation or proper implementation of evidence- based guidelines. YS:As you know, here in the United States, pay for performance is a reality. Hospitals are penalized by the Centers of Medicare when they don’t meet quality, patient safety, and efficiency goals. Are there similar goals to be met within the GCC and Saudi Arabia? TK: This concept is a new one and I did a revision of this concept and I learned a lot from the USA experience and other experience. It is now implemented in Hamad Medical Complex City in Qatar and some hospitals in UAE and also in Saudi Arabia but it’s not yet as a national approach in the Kingdom of Saudi Arabia, with Vision of KSA 2030 there will be a movement toward this one with the privatization of the healthcare system and also with insurance approach for health care financing. I wrote chapter in my book on this issue. I tried to introduce it but the system in KSA or GCC states is still not yet fit for this concept. There are some articles in the Saudi Medical Journals regarding how to enhance pay per performance as an approach to improve the uptake of clinical guidelines as well as to improve their clinical outcomes. YS:Within the GCC, are there ways that healthcare organizations can benchmark and share data - so that for each country within the GCC – someone can compare across the region? TK: We agreed on 48 indicators and it’s a comparison indicators for each countries but keeping in mind that Saudi Arabia is a very huge country compared to Qatar and Bahrain and United Arab Emirates -- especially Bahrain and Qatar. It should be reported in GCC Health Ministers Council every year and it is published annually. We try to learn from each other, especially to get benefit from the centers of excellence from each country as well as to make sure that all our healthcare in the GCC are up to their standards compared with the international standards of good quality of care. So we compare GCC states in these indicators for the performance of the healthcare with American, British, Australian and France and others. So we are comparing us with the developed countries and also we try together as GCC countries to adopt a collective approach in order to reduce the cost, as well as utilize the experience from others in a proper way. So there is a work done in the GCC to monitor the progress of healthcare using agreed upon indicators and also to learn from each other on a monthly basis or weekly basis. So we have every year more than 45 to 50 committees meeting to discuss healthcare agenda for different specialties. Also we have a committee for vital statistics and healthcare indicators and committees for IT and technology. So all of these, they meet together in order to make sure that the system in the GCC is up to the right level of quality and good care and the same time to learn of each other and how to improve together the status of Healthcare provision in the GCC. So this is the main job of the Health Minister Council Office in the GCC to make sure that we learn from each other, we work together for better health in the GCC countries.
YS:One of the impediments to improving patient safety here in the United States is the lack of interoperability of different EHR systems from different vendors. Another of our 2016 SafeCare nominees for SafeCare Person of the Year is the CEO of Telmex in Mexico where they implemented one EMR system across the entire country, with spectacular results. Is this something that the GCC does? TK: Actually that’s very important issue, it is the center or the heart of the problem. I think this is a problem we are facing for the last 10 years or more. We need to have a unified system for EHR in the GCC and there was an order from our leaders, the governance of the GCC countries to move in this direction. I think five years ago we had a ministerial resolution to have a unified one for all GCC countries. But since that time until now, we had many meetings. We tried to make some sort of adaptation and actually we came to some agreement but whenever we come to the reality, there is a problem. I’ll give you an example. Saudi Arabia, we have more than 15 sectors that delivers healthcare including the private sector. Everyone, they have their own EHR and with the Saudi Council for Health, one of the strategic target is to have a unified EMR and also to make sure that we have a national medical record and the aim is to have a GCC Medical record WITH a unified number for healthcare, for all GCC citizens. Until now, the process is tedious and a lot meeting and a lot of resources were allocated. We had conference last year in Kuwait and there was a lot of hot discussion on this area. What indicators would be there? What data it should be reported and also the people from the Minister of interior and others, they have their own structures and views. So different sectors, they have different approaches. Along with that there are different approaches in the Ministry of Health and others sectors providing healthcare in the GCC countries. So this is a big issue. This is not an easy subject to review. YS:You have also written extensively about medication errors. Can you tell us about efforts to reduce prescribing and administration errors across the GCC? TK: Yeah. Thank you. This is my piece of cake. I started to working in medication area in 1996. I published an article in one of the American journals and it was revising prescription in the primary healthcare and I know when I visited as a supervisor and a decision-maker in the KSA as the Director for the Health Center. I found there is a lot of medication error when I looked at the prescriptions, there were a lot of mistakes and there was not system to monitor the prescribing errors or advise doctors or to look at what is the contraindications so on and so forth, especially in the remote areas. So I started to work on this one from 1990 and in 2001, I published a guideline on this area and in 2006, I did another study on this area and it shows that the prevalence of medication was increasing in the city Riyadh. So I took from that how to combat or how to overcome this issue. So we consulted with international people from the US, U.K., Canada to come and to help us in developing the system to reduce medication errors and prescribing error in the GCC. So we have a special workshop in 2005, where His Excellency Sir Liam Donaldson and others came from UK, Geneva to help us in putting the issue in the right direction. Then we had so many meetings in this area, training workshops, developing curriculum for doctors, for how to have a proper prescribing. Also we introduce systems like the PACT system. We asked healthcare institutions to adopt computerized medication practice and risk management approaches. Also we introduced the accreditation system. So within the system, there is a component about the issue of prescribing and administrator error and so on. Also we asked some of the universities in the GCC, especially the KSA to introduce the specialty of clinical pharmacists. So this specialty is that he or she is more authorized to direct the clinicians and prescribing practitioners and to monitor the prescribing pattern. Also we formulated a strategic plan of action that we ask every ministry of health to have their own departments for good pharmaceutical care and within this pharmaceutical department, there is a department for prescribing error. Also we encourage colleagues to report such issue so we have a reporting systems within the risk management approaches. So this effort in the medication error became a very important issue. And also we had conferences for counterfeit drugs. Workshops and training on counterfeit drugs and we ask people from different organizations to joined and help us in developing the post marketing surveillance system in the GCC. So as you see, there is movement from different perspectives as well as we develop in the GCC group procurement for pharmaceutical products and supplies. So we have a unified group recruitment of pharmaceutical supply to all GCC countries and we have GCC Center of Registration for pharmaceutical products. So any drugs or many pharmaceutical product coming to the GCC should be registered and in the registration there is transparency about the effectiveness and the productivity and the availability of that drug. We try to make sure that there is proper handling of pharmaceutical products and prescribing, dispensing, storages as well as to maintain a good cold chain. There is a monitor of the cold chain for vaccine, serum and other -- it is one of the top priority areas. As I mentioned earlier, both medication error and malpractice are the top priorities for quality and patient safety and we have postgraduate candidates for master degree and PhD to take this in their area. So you can see in the last few years, there was a lot of communication and efforts to address the prescribing errors, compliance, adherence and all of these areas is becoming a way of life in most of the healthcare institution in the GCC countries. YS:What advice you have for other nations which are considering the implementation of Centers for Health Excellence? TK: Thank you so much. With humble approaches. Considering the implementation of Centers for Health Excellence, first, of all do your best to gain the necessary commitment is very important. So without total accountability and commitments from the higher authorities things may go somewhere else. Why I’m saying that’s political commitment because there would be a lot of difficulties and people, they may -- don’t like it. People like to be free and they are trusted. So when you have political commitment, you will move forward. We say in Arabic that (Almighty Allah order cannot be fulfilled without -- order from the political people). Second, you need to invest your local needs. So you need to do a needs assessment. Third, whenever you are trying to have a center of excellence, you invest in leadership of government. So national people should get over and -- leaders from your country should take over. You learn from others. You learn from experts from U.K., USA, Canada and others. But you need to build up your capacity with the national one. Fourth, you need to have a clear right national strategy. The fifth is that, make sure that you have a plan of action to sustain the process and that there is a need for accountability. There is popularity to that center. So you need sustainability, otherwise after a while everything will subside down. Make sure that whenever you are looking for a center of excellence, a process of sustainability and maintain process is there. And lastly, I think that -- it’s not the least, I think this is the core of them all, that you aim, my aim and other people’s aim is: the right of the people in the healthcare and how we can both -- the center of excellence, dealing with people centered-care and I always say that: You should see the patient as if you are the patient in the eyes of the patient. So how can I move to this concept and how can I make this center as a center of the people to maintain the health of the people? So these are some of my advices. I hope I have the right ones.
YS:In all the years you have worked in healthcare, what were you biggest challenges working with healthcare leaders from the different GCC countries? TK: Yes and even I have another job which is called the General Secretary for Hospital Alliance in Arab Countries. There are 22 countries -- I think it needs a lot of diplomacy, understanding, and coordination. Though we have a similar culture in the GCC to some extent, the biggest challenges working with healthcare leaders from different GCC countries is that you have different system; different developmental stages of performance; different priorities and also situations; the ambitions of the leaders of healthcare is different – even each GCC states has its own health strategy. So this means that you need to do a lot of work to bring them together, a lot of effort to have an agreement from the countries or to convince the health care leaders and you need to have the right skills and experience how to manage the change. But as you are in a position of leadership in healthcare in these countries whatever you are trying to do is worth and it does have a value. Another challenge is really -- the biggest challenge that I face in the GCC that shortage of qualified healthcare workforce. The GCC countries are suffering a lot from shortage of national human resources in health care and we are really in a very difficult position in this regard. Moreover, the leadership development for healthcare is another big issue. It is a crucial issue. I think this is one of the biggest challenges and it needs a coordination between all these countries. So what we did to overcome this problem that we collaborated with, and try to open the access for overseas training and also try to connect the GCC with different respected centers of excellence for training: John Hopkins, Harvard, Imperial College and others in order to develop interest leadership in healthcare profession. So this is the way forward. We work together. We try to compromise -- to understand -- better cooperation in order to have proper outcome in working together within the context of different countries in the era of evidence – based health care, quality and patient safety and the health care system should respect the patients’ rights. YS:Thank you Dr. Khoja for yeoman’s work of saving lives, preventing infection spread and achieving the ultimate goal of providing world-class healthcare services free of patient harm to the countries of the GCC. What you’ve done with the executive board of the GCC is just fantastic work. We need to stay in touch, you and I. TK: Insha'Allah. I will not forget your friendship, support and encouragement. I do not have words to express my gratitude for all your guidance, and your recognition as of our work in this part of the world as you are an international medical society specialized in quality and patient safety, and we trust that we will keep in touch. Wishing you all success and prosperity. YS: Insha'Allah.
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