Transforming Care for Older Adults in the Kingdom of Saudi Arabia: An Age-Friendly Health Systems Journey
IHI's partnership with the Ministry of National Guard Health Affairs (MNGHA) in the Kingdom of Saudi Arabia has supported the implementation and spread of the Age-Friendly Health Systems (AFHS) 4Ms Framework (What Matters, Medication, Mentation, and Mobility) across multiple care settings, with the goal of improving the quality, safety, and experience of care for older adults.
Impact at a Glance: Age-Friendly Care
~70%
Care grounded in the 4Ms Framework increased from less than 10% to approximately 70% in under two years
3,000+
Older adults received age-friendly care during the project period
5 hospitals
Established routine delirium assessments across the region
19 sites
Established “What Matters” as a core component of care
IHI's role:
- Guided implementation of the 4Ms Framework using internationally tested, evidence-based improvement methods.
- Deepened learning and local adaptation through mentorship from experienced international Age-Friendly leaders who have successfully implemented care at scale.
- Connected MNGHA with additional subject matter experts to foster relationship-building and future collaboration opportunities.
- Provided platforms for MNGHA to disseminate their progress.
- Advised on future Age-Friendly strategic plans and helped build capability among team members.
Nouf Al Qahtani
Integrated Care Specialist, Integrated Excellence Services Delivery, Clinical Strategy Department, Ministry of National Guard Health Affairs
Integrated Care Specialist, Integrated Excellence Services Delivery, Clinical Strategy Department, Ministry of National Guard Health Affairs
This project has had a significant and positive impact by strengthening collaboration, improving efficiency, and delivering tangible outcomes aligned with its objectives. It has contributed to building sustainable processes, enhancing knowledge exchange, and creating measurable value for all stakeholders involved. Overall, it has laid a strong foundation for continued growth and long-term success.
Raneem Milyani, MD
Director, Integrated Excellence Services Delivery, Clinical Strategy Department, Ministry of National Guard Health Affairs
Director, Integrated Excellence Services Delivery, Clinical Strategy Department, Ministry of National Guard Health Affairs
The IHI team consistently demonstrated exceptional expertise, preparedness, and responsiveness throughout the journey. Their ability to provide timely guidance, connect us with the right resources, and offer practical solutions to implementation challenges was outstanding.
The Challenge
As the population ages, healthcare systems are caring for an increasing number of older adults with complex medical, functional, and social needs. Historically within MNGHA, care for older adults was often delivered through condition-specific approaches, and the key elements of age-friendly care were not consistently assessed, documented, or acted upon across inpatient, outpatient, and emergency department settings.
This created challenges in ensuring that:
Care aligns with what matters most to older adults and their families
High-risk or unnecessary medications are identified and addressed
Risks related to mentation, including dementia, delirium, and depression, are recognized and managed
Mobility is preserved to prevent functional decline and improve outcomes
The initiative sought to address this gap by helping clinical teams systematically implement the 4Ms Framework of an Age-Friendly Health System, ensuring that every older adult receives reliable, evidence-based, and person-centered care regardless of where they enter the health system.
The Goal
The collaborative aimed to implement the 4Ms Framework of Age-Friendly Care in 80% or more of older adult encounters across inpatient, outpatient, and emergency department settings by October 31, 2026.
The 4Ms Framework supports the objectives of Saudi Arabia Vision 2030 by advancing high-quality, person-centered care for older adults. By improving care coordination, reducing avoidable harm, and promoting functional ability and independence, the framework contributes to Vision 2030's goals of enhancing healthcare quality, increasing healthy life expectancy, and fostering a healthcare system that meets the evolving needs of an aging population.
The Approach
IHI implemented a Breakthrough Series (BTS) Collaborative, bringing together 19 teams across four regions in the Kingdom of Saudi Arabia and five settings of care: inpatient, outpatient, emergency department, chronic disease management, and primary health.
Key components of the collaboration included:
Supporting executive and clinical leaders in building awareness and capability around age-friendly care principles.
Providing coaching and technical assistance to multidisciplinary teams participating in a structured quality improvement collaborative.
Guiding teams in the implementation, measurement, and documentation of the 4Ms Framework (What Matters, Medication, Mentation, and Mobility) across inpatient, outpatient, and emergency care settings.
Facilitating learning sessions, workshops, and peer-to-peer sharing opportunities to accelerate implementation and spread of best practices.
Assisting teams in the use of quality improvement methodologies, including aim development, testing changes through PDSA cycles, and establishing reliable measurement systems.
Helping organizations prepare for and pursue formal Age-Friendly Health System Recognition by ensuring alignment with the established recognition criteria and evidence requirements.
Creating a regional learning community that enables participating sites to share successes, challenges, and lessons learned while advancing age-friendly care across the Kingdom.
The collaboration has focused not only on implementing evidence-based practices for older adults but also on strengthening organizational capability for sustainable quality improvement and system-wide transformation in healthy aging and age-friendly care.
Results
Together, IHI and MNGHA have made significant progress in advancing age-friendly care, including:
Engaging more than 50 health care professionals who have been trained and are actively engaged in delivering age-friendly care
MNGHA is the first organization in the Middle East and North Africa (MENA) region to reach AFHS Level 2 recognition (Committed to Care Excellence recognition) across all 5 care settings (inpatient, ED, outpatient, primary care and chronic disease management) simultaneously, setting a benchmark for excellence
Providing age-friendly care to over 3,000 older adults
Introducing the 4Ms to other units within healthcare settings and to newly opened hospitals within the health system
Charts:
Cognition Screening: Line charts showing dementia screening increasing from approximately 14% to 84% and depression screening from 25% to 87% between January 2025 and August 2026.
What Matters Documentation: Line chart showing the percentage of patients with “What Matters” documented increasing from approximately 61% to 83%, with a peak of 94%.
Delirium Screening: Line chart showing inpatient delirium screening increasing from approximately 3% to nearly 100% between January 2025 and August 2026, with a temporary decline in December 2025.
4Ms Framework: Line chart showing the percentage of patients receiving care aligned with all four 4Ms, with the charted baseline increasing from 53% to 74%, followed by a decline to approximately 61% in August 2026.
Learnings
Multidisciplinary collaboration is essential for age-friendly care.
Implementing the 4Ms Framework highlighted the importance of bringing together many different groups of healthcare professionals to address the complex and interrelated needs of older adults. Collaborative work enabled a more person-centered approach to care.
Understanding and acting on "What Matters" can transform care delivery.
Embedding conversations about what matters most to older adults shifted care from a disease-focused approach to one that aligns care decisions with individual goals, preferences, and values.
The Age-Friendly Health Systems Framework is adaptable across diverse cultural and healthcare settings.
This work demonstrates that the 4Ms Framework can be successfully implemented within the Saudi Arabian context while respecting local cultural values, family involvement in care, and organizational priorities.
Data is a powerful enabler for improvement.
The systematic collection and review of data enabled teams to identify gaps, monitor progress, guide improvement efforts, and demonstrate the impact of age-friendly interventions over time.
Leadership support is critical for sustainable change.
Strong sponsorship from organizational and clinical leaders helped build engagement, remove barriers, and embed age-friendly practices into routine care.
Small tests of change accelerate adoption and learning.
Using a structured quality improvement approach allowed teams to test, adapt, and refine interventions before scaling them more broadly. This iterative method reduced implementation challenges and enabled solutions to be tailored to local needs and workflows.
Building capability creates the foundation for spread and scale.
Investing in staff education and improvement capability helped develop local champions who could sustain the work and support its expansion across additional units and facilities.
Hear from Dr. Raneem Milyani, Director of Integrated Excellence Services Delivery in the Clinical Strategy Department at MNGHA, about key strategies, lessons learned, and reflections on the importance of this work in the video below.