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The fifth road: Leading healthcare in the Ebola era

By Kimberly Mitchell | Thursday, August 28, 2014

Kedar Mate is Senior Vice President at IHI. 


Last week, concerns about a possible case of Ebola reaching beyond the borders of Africa and into the Middle East raised alarm bells all over the world, particularly among government leaders and experts in the region.  Although the patient was subsequently found not to have the disease, the outbreak of Ebola virus in Africa follows closely on the heels of the still unresolved epidemic of Middle East respiratory syndrome coronavirus (MERS-CoV).  Concerns abound amongst health care leaders in the Middle East about how to curb the spread of these latest medical threats to an already strained Middle Eastern health and hospital system. 

According to the Population Reference Bureau, population growth in the Middle East has quadrupled since 1950, and the economy has seen equally dramatic growth and development. Prosperity, particularly in the Gulf countries, has resulted in shifting demographics and epidemiology, with growing populations of patients both young and old suffering from diabetes, cardiovascular disease, and rising burdens of cancer throughout the region. In addition, large expatriate worker populations moving to and from the region add new challenges for health care leaders in terms of disease management and control.

These conditions are met with increasing interest in health from a citizenry that, rightfully, seeks better, higher-quality performance from their health systems. Patients, increasingly, take to social media and other non-traditional outlets to express their concerns about waiting times, unsafe practices, and unprofessional treatment.  And the financiers of health—governments, insurers, and, ultimately, patients themselves—similarly demand greater value for the increasing resources that are invested in health.

How to stay competitive and manage all of this in an increasingly demanding market environment? 

There have been four standard responses to date in the region. Let’s call them the 4 T’s: temple, technology, talent, and, failing those, trimming. 

  1. Temple: These days, all over the world you see magnificent new infrastructures for health care being built at great cost. Beautiful new hospitals, clinics, and other facilities (“temples”) with high capital costs and large maintenance budgets, these are attractive solutions to developers and health care leaders as a way of developing a new material asset for a community and renewing public confidence in a health system that may have suffered from years of neglect and disrepair.
  2. Technology: The second response has been to stock the “temple” with the latest and greatest gadgets and technologies that patients might want. In part, this is about making sure that the shelves are stocked with critical medications and supplies that would otherwise make for unsafe and inadequate care. But it can be taken to an extreme: in one hospital, I was proudly shown not one but two proton-beam therapy machines and no fewer than four MRI machines.
  3. Talent: With the best infrastructure and now the best technology, the theory goes that you need the world’s best health care personnel to operate the hospital.  Talent management is a big business in the Middle East, with recruiters fanning out all over the region and all over the world to get the very best doctors, surgeons, and leaders to join their health care team. Leaders employing this strategy rely on the star power of individual physicians and surgeons to attract new patients to their system.
  4. Trimming: Some systems can’t afford the infrastructure development, the latest technologies, and the world’s greatest talents. For those systems, cost containment is the strategy to remaining viable.  They are going the road of the budget airlines: trying to maximize value by reducing cost, while hopefully not compromising on quality.

There is a fifth road, however, that is less well travelled: a relentless focus on clinical and operational processes to improve service reliability, safety, and effectiveness, and remove inefficiencies, delays, and harmful care.  The road to higher-quality care at lower cost—has resulted in better outcomes for patients, better use of resources, and improved patient experiences. 

Travelling this fifth road requires effective leadership and a commitment to quality as a core business strategy for a health care organization. The ability to achieve those goals of better health, better care, at a lower cost will be what distinguishes a good system from a great one.  Leaders who embrace the challenges of today and who innovate and try small tests of change to achieve real quality improvement will be the ones who will best manage the ever-changing landscape of health care in the Middle East.  In fact, the fifth road is one that makes sense for health care organizations all over the world.

Learn more about how to lead your organization to quality at the Executive Quality Academy

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