Patient Experience Measurement Program in Saudi Arabia.

Patient Experience Measurement Program in Saudi Arabia.

Improving the healthcare sector is one of the top priorities in most countries around the world, and this is accomplished by providing patients with innovative and high-quality services. Healthcare is measured by the quality of services provided and the level of patient safety. According to Teno et al. (2018), healthcare systems are a critical resource in any nation that plays the role of sustaining the well-being and health of its people; thus, they must be prioritized. Indeed, the healthcare sector is one of the Ministry of Health’s (MOH) primary focus areas, and the country is constantly striving to develop policies that ensure patient safety and the provision of high-quality services to all citizens. As a result, healthcare institutions must ensure that their customers’ needs are met, as measured by patient satisfaction with service and service quality. Having an estimated

Saudi Arabia, with a population of 34.14 million people, is one of the largest Arab countries, with over 7 million non-Saudis (Chai, 2017). Furthermore, it is the most prominent Muslim country in the world, attracting millions of visitors for religious and professional reasons. As a result, healthcare professionals in Saudi Arabia encounter patients from a variety of cultures, nationalities, religions, and educational backgrounds. This presents some challenges in terms of service delivery and patient safety (Chai, 2017).

According to Teno et al. (2018), the primary goal of providing quality management services in any healthcare institution is to ensure that the organizations are capable of providing the best possible healthcare service that meets the customers’ expectations and needs. According to Cullati et al. (2019), many healthcare institutions are now using quality management as a strategic tool to achieve the highest level of competitiveness and performance. Furthermore, the author discovered a positive relationship between an organization’s performance and quality improvement. Quality management was only recently recognized by researchers as a viable means of establishing a sustainable competitive advantage, as shown in other sectors, yielding in business optimization, process improvement, performance improvement, and waste reduction. Simply put, quality management is a must-have for any organization seeking to achieve peak performance.

Patient safety, like quality management, is a critical component in any healthcare institution. Over the years, there has been an increase in concern about patient safety in healthcare organizations, which leads to additional healthcare complications that could have been avoided. Furthermore, millions of patients worldwide suffer from avoidable harm, making patient safety a major public health concern. Indeed, the WHO (2019) estimates that four out of ten patients in primary and emergency care settings are harmed as a result of unsafe care practices on a global scale. Patients’ safety is important because it causes adverse events, which are one of the leading causes of death and disability worldwide. Even in developed countries, such health-related incidents occur, with one in every ten people receiving care in a healthcare facility. Unfortunately, according to WHO (2019), 50% of these events are preventable. Over 134 million cases of adverse events occur in low- and middle-income countries each year, resulting in 2.4 million deaths. According to the World Health Organization’s (2019) report, nearly 66.6% of deaths and injuries in adjusted life years are caused by unsafe disability and care.

It is critical to discuss aspects of quality management and patient safety in order to better understand the service delivery performance of healthcare in Saudi Arabia. As a result, this paper will look at two aspects: patient safety and quality management.

Justification

To justify the importance of quality management and patient safety in healthcare in Saudi Arabia, the current situation in the country must be depicted.

Saudi Arabia’s Quality Management Perspective in Healthcare

Article 31 of Saudi Arabia’s constitution states that the Saudi government, as a welfare state, is responsible for providing free services to all citizens. According to the development of health policy, Saudis have the right to freely obtain care and treatment that meets quality standards. As a result, Saudi Arabia strives to have a comprehensive and successful healthcare system that provides a wide range of preventive, curative, and rehabilitative services. Despite the common challenge of defining quality management in relation to healthcare systems, Saudi Arabia has been focusing on improving all aspects of quality management in healthcare for the past few years. Because of the involvement of individuals in the delivery and creation of healthcare services, defining quality in service is difficult (Rahman, 2020).

A comprehensive definition of quality management in healthcare is required. According to Ayuso-Murillo et al. (2017), one of the key issues impeding the implementation of quality services is a lack of definition clarity. As a result, a complete and clear definition of the term is elusive. Another factor limiting the definition of quality management is the fact that healthcare institutions operate at various levels with varying expectations and values. To provide a comprehensive understanding of quality management, it is necessary to focus on people’s preferences in order to satisfy and thoroughly survey their needs and expectations.

Despite the fact that quality management is an important aspect of healthcare service delivery, there has been little research on its implementation in Saudi healthcare organizations. However, Ayuso-Murillo et al. (2017) state that, in order to improve the healthcare sector, quality management is mostly implemented in the public sector. Since 1990, the Ministry of Health has been promoting healthcare services through quality management, with positive results. Saudi Arabia’s quality management system works best in the country because it is tailored to the structure and culture of the country’s healthcare institutions. Hundreds of expatriates work in healthcare in the country, and the MOH has been organizing various pieces of training for both Saudi and non-Saudi doctors, with a particular focus on middle management, to promote quality of service. Despite being the key leaders in the implementation of quality management, top management’s concepts and practices were relatively low due to a lack of awareness. Quality management in Saudi Arabia is generally based on organizational outcomes, performance, and innovation performance. More specifically, in Saudi Arabia, the main force necessitating improved service quality was the demand for healthcare services due to rising costs and renewed public pressure. In general, the factors identified by 40% of primary care patients as limiting service quality were a lack of an integrated IT network, handwritten referrals, and language barriers. Ayuso-Murillo and co. (2017).

Saudi Arabia’s View on Patient Safety in Healthcare

Every patient in Saudi Arabia has the right not only to free medical care but also to protection and a safe environment. Patient safety is inextricably linked to organizational culture. Patients’ safety is frequently jeopardized, resulting in deaths and negligence, patient dissatisfaction, medical errors, and injuries to healthcare providers. It is commonly assumed that safety issues arise as a result of unintentional mistakes and errors, as well as safety violations. Saudi Arabia, like any other healthcare system, faces a wide range of patient safety challenges. As a result, authorities are responding to the media’s attention-grabbing stories about rising medical errors. As a result, improving quality management, particularly the quality of healthcare services, is the most viable solution to improving patient safety. Several initiatives have been put in place to improve the situation, primarily initiating credential schemes and establishing medical standards (Aldosari, 2017).

As previously stated, having a healthcare system that supports quality management and ensures patient safety is critical. Quality management and patient safety are two major issues that are inextricably linked. As a result, in Saudi Arabia, it is necessary to discuss the benefits of quality management as well as patient safety.

General Considerations

This section will examine the current literature on the subject in order to provide a thorough understanding.

According to Jacobs et al. (2018), quality management is a requirement for any healthcare system, and satisfactory quality management includes six elements: cost reduction, customer satisfaction, education and training, leadership and commitment of the top management team, and organizational and teamwork culture. Based on these factors, a quality management model was developed that included the following dimensions: full participation and involvement of the staff, the commitment of top leaders, training and education, empowerment of the staff, process management, customer service focus, teamwork strengthening, an open analysis, information, and organizational system, and strategic planning. Education and training were viewed as critical dimensions in initiative implementation in the quality management model. This is because it provides healthcare practitioners with the necessary skills and knowledge to help them achieve better service delivery, as well as identify quality management goals and ways to achieve them. Jacobs et al. (2018) conducted a study in Riyadh to further investigate this issue, and they discovered that the first step to better implementation of a quality care system in any hospital was to develop a quality system and then determine the measures for quality progress. The researchers emphasized the link between training and education, and service quality in their findings.

Rocha et al. (2017) conducted a study to investigate quality management in Saudi Arabian hospitals. The overall findings revealed that the majority of the region’s healthcare institutions received very low scores for quality management implementation and a medium score for quality management. This indicated that there were potential issues that needed to be addressed. Furthermore, the findings revealed a link between continuous improvement and service quality, as quality management aids in the evaluation of processes in order to provide patients with high-quality care. The lack of involvement and empowerment of healthcare providers, particularly nurses, was identified as a major barrier to the provision of quality care services in Saudi Arabia. As previously stated, the elements that frequently lead to successful quality management can be determined by nurses’ involvement in the process of care delivery as well as patient behavior. Simply put, internal quality management is possible. Furthermore, the findings indicated that hospitals should involve patients in the delivery of services by listening to their preferences for care options. As a result, patients’ satisfaction and fulfillment levels are frequently increased. The purpose of a quality management system, according to the researchers, is to meet and exceed the needs and requirements of customers, their families, the community, and healthcare providers.

According to a WHO report (2019), disability-adjusted life years affect approximately 64 million people as a result of unsafe care. This means that one of the leading causes of death in hospital settings is a lack of patient safety. According to the report, healthcare systems around the world are operating in increasingly complex environments as the landscape changes. The introduction of new technologies, treatments, and care models poses a novel threat to safe care. Many countries, including Saudi Arabia, are grappling with the issue of patient safety; as a result, WHO (2019) recommends that every country strive to improve its healthcare delivery process by prioritizing healthcare in its Sustainable Development Goals. Furthermore, as Saudi Arabia’s population grows, several changes and improvements to the healthcare sector are being implemented to improve service delivery quality. In fact, the Ministry of Health (MOH) has been tasked with delivering the recently launched “Vision 2030” for the Kingdom of Saudi Arabia in collaboration with the National Transformation Plan (NTP). Transforming healthcare is the first theme of “Vision 2030,” and this paper will investigate the strategic goal of improving healthcare standards and providing access to healthcare (Arabia, 2017). The Department of

Health and the GAPC-MOH have conducted numerous studies on the challenges that Saudi health organizations face. This enables them to create solutions that improve healthcare organizations’ capabilities as well as the quality of care they provide. As a result, as previously stated, Saudi Arabia is at the forefront of providing quality healthcare in accordance with World Health Organization standards (WHO). Furthermore, WHO (2019) defines patient safety as including healthcare-associated infections, medical errors, unsafe injection practices, poor and negligent surgical processes, sepsis, and other conditions. To improve patient safety, the global organization created the World Health Assembly, which allows for an annual meeting and discussion on how to improve quality of care and patient safety; its mission is “quality of care; patient safety.”

Furthermore, Alotaibi et al. (2018) conducted a study in Saudi Arabia to establish a comprehensive link between healthcare quality management and patient safety. The study’s findings revealed that in order to provide quality care to patients, it is necessary to understand traditional Muslim values and beliefs about care. As a result, healthcare providers must be educated and trained on Muslim beliefs in order to provide better care. The author suggests that hospitals implement the Leininger culture care model in order to provide high-quality, satisfactory health care and promote patient safety. This model explains how to develop and implement quality management strategies by defining healthcare practices such as maintenance, prevention, accommodation, culture care, treatment, and negotiation. The study included physicians as participants, who stated that there is a link between patient safety and quality of care and current organizational culture. Thus, in order to meet patient’s health requirements and needs, healthcare providers must be culturally sensitive.

Almalki et al. (2017) also conducted research to assess the role of healthcare providers in ensuring patient safety and improving service quality. According to the study’s findings, healthcare practitioners, particularly nurses, must be empowered in order to improve their job satisfaction and service quality. In Saudi Arabia, nurses’ job performance was rated as moderate. The study included 632 nursing staff from one region of the country and three distinct segments: public, private, and military healthcare institutions. As a result, the authors proposed that nurses’ job satisfaction be improved by providing a pleasant working environment, higher pay, education and training, promotion, and participation in institutional decision-making.

Discussion

Saudi citizens are provided with healthcare at three levels: primary, secondary, and tertiary care, as illustrated in Figure 1. As a result, in order to better analyze the implementation of quality management and the level of patient safety in Saudi Arabia, the issue will be examined at three levels: local, national, and international.

Figure 1: MOH-provided healthcare services

At the local level

This is grassroots healthcare, where primary care is provided. With the signing of the “Alma-Ata Declaration” in 1978, healthcare services were made available at the local level in Saudi Arabia, with the primary goal of ensuring that every Saudi has access to healthcare. At the local level, there are currently over 3,000 healthcare institutions, and the MOH is working to increase the number in order to reach as many people as possible (Mahrous, 2019). The MOH is working to improve healthcare at the local level because 60% of Saudis prefer it to hospitals at the national level (Mahrous, 2019). According to the findings of this study, the quality of service and level of patient safety in Saudi Arabia is extremely low. One of the limiting factors is communication barriers because the majority of doctors at the local level are expatriates who face difficulties communicating with locals. At the local level, there is a lack of a strong doctor/nurse-patient relationship. As a result of these challenges, healthcare providers face a greater challenge in meeting the needs of their patients. Patient satisfaction is the most important metric for measuring service quality. Organizational effectiveness and service quality have a positive impact on consumer satisfaction. Another factor preventing quality service at this level is the physician’s and patient’s limited communication time. “Chain of command” was a factor that was lacking at the local level in order to achieve quality service and improved patient safety because nurses are required to contact as few people as possible to minimize infectious disease transmission (Mahrous, 2019).

Furthermore, quality management and patient safety are low at the local level because the quality of services is hampered by a lack of an accurate documentation system. A functional information system that keeps patients’ medical records is required for any healthcare institution. Poor documentation is one of the underlying causes of poor performance in quality measures. A poor documentation system also affects the ability of healthcare providers to receive the most appropriate and accurate amount of payment, as well as the patients’ costs that should be paid. According to Sun et al. (2018), a documentation system was developed with the goal of providing physicians with a record of the patient’s medical profile. This can be done either electronically or on paper. With the advancement of technology, hospitals must engage in technological advancements to improve an electronic database of patient information. Local healthcare institutions in Saudi Arabia continue to rely on handwritten medical records. In Saudi Arabia, the implementation of an electronic system is hampered by nurses’ perceptions of the system. Most nurses claim that they spend the majority of their time on electronic health records, which leaves them with less time to care for patients. Others claim that the electronic system impairs their critical thinking ability because there is a lack of complete understanding and need for detail of the patient’s physiological and physical health. To improve the quality of care and increase patient safety at the local level, the MOH must improve education, training, and awareness among healthcare providers.

National Scale

Secondary and tertiary care is provided at the national level in Saudi Arabia. Secondary care, like primary care, is an important component of the country’s healthcare system because referrals for additional treatments are made to this level. The majority of national healthcare institutions are located at the district level in general hospitals and are managed by regional directorates. On a national scale, there are several private hospitals. The country’s massive oil reserves allow Saudi authorities to build more hospitals, resulting in a large number of hospitals at the national level. Saudi Arabia has seen the decentralization of healthcare institutions from the previous specialist hospitals in Riyadh to other regions of the country. Furthermore, there are tertiary care hospitals on a national scale. These are hospitals that care for patients who have long-term illnesses and are usually referred from general hospitals. These institutions have modern medical equipment and experienced medical personnel because they deal with complicated health situations (Almoallem et al., 2020).

In comparison to other developed countries, the national level of quality management awareness lags far behind because of a lack of understanding about the evaluation of quality care. However, since the 1980s, the national level of healthcare service quality has been improving. In 1984, Saudi Arabia’s Ministry of Health launched initiatives to improve healthcare quality through the implementation of a National Development Plan that emphasized patient-centered care. The National Committee on Quality Assurance was established in 1993 to strengthen healthcare at the national level, and care standards were based on those approved by the World Health Organization (WHO) (Almoallem et al., 2020). In 1995, the Management Development Programme was launched, outlining the roles of regional supervisors in providing quality and improved healthcare, particularly primary care. As previously stated, the Saudi government has been making efforts to improve quality and increase patient safety since the 1980s. Transformational changes in quality management are most visible in healthcare facilities. These institutions are mostly run by Western companies, and the majority of healthcare providers are foreign nationals. Furthermore, in specialized hospitals such as King Khaled Eye Specialist Hospital Services, quality management is prioritized (KKEH).

A case scenario of a healthcare institution will be discussed to provide a thorough analysis of the state of quality management and patient safety in Saudi Arabia.

King Khaled Specialist Eye Hospital (KKEH)

The primary goal of this institution is to provide cost-effective and high-quality healthcare to all of its patients while adhering to Quality Assurance principles. Furthermore, the standards followed are JCAHO’s, and the management believed that implementing these standards was effective because the institution’s management is operated by a foreign company in America. The MOH is responsible for ensuring that operations in the healthcare institution run smoothly, which includes providing education and training to specialists. Previously, KKEH faced a number of challenges in implementing quality management and ensuring patient safety. The challenges include a lack of an organized quality assurance department, a lack of standards to govern operations, a lack of workforce education on the importance of quality management, and a lack of performance measurement standards (Alqasimi, 2017).

Furthermore, at the national level, the MOH has always been at the forefront of ensuring quality improvement. MOH has undertaken several initiatives for improvement after realizing that quality management and improving patient safety were working in facilities such as KKEH. These efforts include developing a Quality Assurance Program and restructuring the organizational structure. Improving quality is a continuous process that is now required because it is directly related to the overall development of healthcare (Alqasimi, 2017).

Level International

At the international level, the Saudi Ministry of Health is working to improve service quality and patient safety in accordance with WHO guidelines. Aspects of quality management and patient safety do not take a geographical approach on a global scale because they are considered universal. The Saudi government, for example, entered into a “Alma-Ata Declaration” because of its willingness to learn from the rest of the world, particularly Western countries. In general, the Quality Assurance principles being implemented in Saudi Arabia are based on WHO guidelines.

Actualization

This paper provides insights into quality management and patient safety issues in Saudi Arabia’s healthcare system. The cornerstones of a functional healthcare institution, as well as improved performance, are quality of care and patient safety. It is impossible to provide quality medical care without the collaboration of all healthcare stakeholders, including healthcare practitioners, patients, hospital administration, and legislators. There are currently several established standards and principles that allow for improved quality of care and patient safety.

Conclusion

Quality management and patient safety are critical factors in the delivery of care in any healthcare institution, and the two are inextricably linked. The goal of this research was to look into quality management and patient safety in Saudi Arabia. This was accomplished by investigating the issues at three levels: local, national, and international. It was discovered that the MOH has been working to create a healthcare system that provides the best possible care to parents through primary, secondary, and tertiary care. This study confirmed the importance of raising patient safety and quality of care awareness throughout the Saudi healthcare system through education, training, and empowerment.

Recommendations

This section will provide practical recommendations to improve the quality of healthcare delivery in Saudi Arabia. Because the country is deeply religious, cultural and religious aspects can be incorporated into the care delivery process. Patients’ safety, well-being, rights, and care can only be improved by aligning medical issues with Islam’s various ethical perspectives. Masl’aha, if implemented, is a practical approach because it represents the practicality of Islamic religious teachings, particularly on care (India & Radhika, 2019). Furthermore, because healthcare providers have been identified as key contributors to a high-performing healthcare system, it is recommended that their education and training be intensified and conducted as frequently as possible. This can be accomplished while these people are still in medical schools and universities. Their university and college curricula must include extensive patient safety and quality care education and training.

References

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Alotaibi, G., Mokhtar, S., Taib, C., & Yusoff, R. (2018). The influence of organizational culture and leadership behavior on innovation performance. International Journal of Business Research, 15(5), 47–56.

Almalki, M., Fitzgerald, G., & Clark, M. (2017). Health care system in KSA: An overview. Eastern Mediterranean Health Journal, 17(10).

Almoallem, A. M., Almudayfir, M. A., Al-Jahdail, Y. H., Ahmed, A. E., Al-Shaikh, A., Baharoon, S., … & Al-Jahdali, H. (2020). Top Ethical Issues Concerning Healthcare Providers Working in Saudi Arabia. Journal of Epidemiology and Global Health, 10(2), 143.

Alqasimi, I. E. (2017). Can Total Quality Management improve the quality of care in Saudi Arabian hospitals? A patient and service provider perspective (Doctoral dissertation, University of Salford).

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Ayuso-Murillo, D., de Andrés-Gimeno, B., Noriega-Matanza, C., López-Suárez, R. J., & Herrera-Peco, I. (2017). Quality management, a directive approach to patient safety. Enfermería Clínica (English Edition), 27(4), 251-255.

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In this assignment, you are required to evaluate the Patient Experience Measurement Program in Saudi Arabia. 

– you are required to apply the program evaluation processes in analyzing this program.

Note*: CDC’s Framework for Program Evaluation in Public Health has six connected steps that can be used as a starting point to tailor an evaluation for a particular public health effort at a particular point in time. It also has a set of standards that can be used to assess the overall quality of evaluation activities.

Step: 

1. Engage Stakeholders: Engage stakeholders, including those involved in program operations; those served or affected by the program; and primary users of the evaluation.

2. Describe the Program: Describe the program, including the need, expected effects, activities, resources, stage, context, and logic model.

3. Focus on the Evaluation Design: Focus on the evaluation design to assess the issues of greatest concern to stakeholders while using time and resources as efficiently as possible. Consider the purpose, users, uses, questions, methods, and agreements.

4. Gather Credible Evidence: Gather credible evidence to strengthen evaluation judgments and the recommendations that follow. These aspects of evidence gathering typically affect perceptions of credibility: indicators, sources, quality, quantity, and logistics.

5. Justify Conclusions: Justify conclusions by linking them to the evidence gathered and judging them against agreed-upon values or standards set by the stakeholders. Justify conclusions on the basis of evidence using these five elements: standards, analysis/synthesis, interpretation, judgment, and recommendations.

6. Ensure the Use and Share Lessons Learned: with these steps: design, preparation, feedback, follow-up, and dissemination. For additional details, see Ensuring Use and Sharing Lessons Learned as well as a checklist of items to consider when developing evaluation reports.

–Standards:

Utility standards ensure that an evaluation will serve the information needs of intended users.

Feasibility standards ensure that an evaluation will be realistic, prudent, diplomatic, and frugal.

Propriety standards ensure that an evaluation will be conducted legally, ethically, and with due regard for the welfare of those involved in the evaluation, as well as those affected by its results.

Accuracy standards ensure that an evaluation will reveal and convey technically adequate information about the features that determine the worth or merit of the program being evaluated.

– you are required to apply various feasible program Evaluation tools and techniques to analyze and interpret the contingency.

– you are required to interpret and discuss comprehensively the findings (ACTUAL) as compared with the theoretical information (literature).