Building World Class Alliances in Healthcare - A Bridge to Better Services

1. BUILDING WORLD-CLASS ALLIANCES IN HEALTHCARE BUILDING WORLD-CLASS ALLIANCES IN HEALTHCARE A Bridge to Better Healthcare Services A Bridge to Better Healthcare Services Ahmed Ghali MD Ahmed Ghali MD Assistant General Manager Assistant General Manager Dar Al Fouad Hosp. Dar Al Fouad Hosp.

3. Dar Al Fouad Hospital

4. Dar Al Fouad Hospital is a private healthcare facility located in 6 th of October City, West of Cairo, 32 km’s away from down town. Dar Al Fouad Hospital is a private healthcare facility located in 6 th of October City, West of Cairo, 32 km’s away from down town. The total area of the hospital is 42,000 meters, with the premises occupying 24,000 meters. The total area of the hospital is 42,000 meters, with the premises occupying 24,000 meters. The premises are comprised of a ground floor, beside two levels on top. The premises are comprised of a ground floor, beside two levels on top.

5. The current capacity of the hospital is 144 beds qualified with all necessary medical an nursing requirements. The current capacity of the hospital is 144 beds qualified with all necessary medical an nursing requirements.

6. Mission Mission Our mission is to serve the community through providing high quality medical services at an affordable price. Our mission is to serve the community through providing high quality medical services at an affordable price.

7. Vision Vision Our vision is to GROW Our vision is to GROW In-house: by inaugurating a new building in 6 th Oct main campus. In-house: by inaugurating a new building in 6 th Oct main campus. Locally: by acquisition of the new East Cairo Dar ALfouad Hospital (2015). Locally: by acquisition of the new East Cairo Dar ALfouad Hospital (2015). Regionally: by opening satellites in the Gulf region, north Africa and sub- Saharan Africa. Kuwait branch is functioning. Regionally: by opening satellites in the Gulf region, north Africa and sub- Saharan Africa. Kuwait branch is functioning.

9. DRIVING FORCES: DRIVING FORCES: Cardiology Cardiology Cardiothoracic Surgery Cardiothoracic Surgery Liver Transplant Liver Transplant Oncology Oncology Orthopedic Surgery Orthopedic Surgery

10. Collaboration with Cleveland Clinic Foundation Collaboration with Cleveland Clinic Foundation In 1990’s the concept and vision of DAF owners was to establish a world class service for the cardiac and cardiothoracic surgeries for Egypt and Middle East region In 1990’s the concept and vision of DAF owners was to establish a world class service for the cardiac and cardiothoracic surgeries for Egypt and Middle East region For more than 15 years, Cleveland Clinic Foundation (CCF) has been ranked as the first hospital in the USA in the fields of Cardiology and Cardiothoracic Surgery. For more than 15 years, Cleveland Clinic Foundation (CCF) has been ranked as the first hospital in the USA in the fields of Cardiology and Cardiothoracic Surgery. In 1999, a collaboration agreement was signed between DAFH and CCF. This agreement ensures continuous technical, medical, and administrative support to be provided by the CCF as well as exchange programs for physicians and personnel for training. It also allowed CCF to have a Board seat in DAFH. In 1999, a collaboration agreement was signed between DAFH and CCF. This agreement ensures continuous technical, medical, and administrative support to be provided by the CCF as well as exchange programs for physicians and personnel for training. It also allowed CCF to have a Board seat in DAFH. This was the first affiliation contract done by CCF outside the states and in the middle East Region This was the first affiliation contract done by CCF outside the states and in the middle East Region

11. Collaboration with Cleveland Clinic Foundation Collaboration with Cleveland Clinic Foundation In 2006, the collaboration agreement was revalidated between DAFH and CCF for 10 years including the new extension in east Cairo. In 2006, the collaboration agreement was revalidated between DAFH and CCF for 10 years including the new extension in east Cairo.

12. Partenership with CCF Partenership with CCF Benefits: Benefits: Guided Daf in setting a world class system for work in all hospital departments Guided Daf in setting a world class system for work in all hospital departments Continuous staff development and training Continuous staff development and training Continuous audit on the outcome of care considering CCF as the benchmark . Continuous audit on the outcome of care considering CCF as the benchmark . This helps our hospital in continuous improvement This helps our hospital in continuous improvement

13. Liver Transplant agreement with KYOTO University Liver Transplant agreement with KYOTO University In 2001, an agreement was signed with KYOTO University, Japan for collaboration in liver transplant. In 2001, an agreement was signed with KYOTO University, Japan for collaboration in liver transplant. Several surgeons were invited to Kyoto to attend this program Several surgeons were invited to Kyoto to attend this program Japanese team were involved in our first cases of the program in Dar Al- Fouad. Japanese team were involved in our first cases of the program in Dar Al- Fouad.

14. Building a team for accreditation Building a team for accreditation

15. What does quality mean in healthcare? What does quality mean in healthcare? 15 Quality is doing the right things right, first time and every time Quality is doing the right things right, first time and every time To ensure: To ensure: 1-The best possible outcome for patients 1-The best possible outcome for patients 2-Satisfaction for all our many customers 2-Satisfaction for all our many customers 3-Retentions of talented staff 3-Retentions of talented staff 4-Sound financial performance 4-Sound financial performance

16. Why did DAF seek for Accreditation? Why did DAF seek for Accreditation? Accreditation is not an end in itself, but rather it’s a way to improve quality. Accreditation is not an end in itself, but rather it’s a way to improve quality. It is a tool to assist the hospitals in improving the system framework of all the hospital functions in an integrated well organized manner It is a tool to assist the hospitals in improving the system framework of all the hospital functions in an integrated well organized manner Accreditation is a strong marketing tool Accreditation is a strong marketing tool 16

17. Why Did we choose JCI Accreditation? Why Did we choose JCI Accreditation? “JCI Accreditation is a well established non profit organization that assess the level of performance in relation to established standards and to implement ways to continuously improve the healthcare system” “JCI Accreditation is a well established non profit organization that assess the level of performance in relation to established standards and to implement ways to continuously improve the healthcare system” JCI is considered one of the toughest accreditation agencies that stress on patient safety and processes of care JCI is considered one of the toughest accreditation agencies that stress on patient safety and processes of care 17

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19. Essential elements of a successful strategy Essential elements of a successful strategy Include developing the right culture , Include developing the right culture , attracting and retaining the right people , attracting and retaining the right people , devising and updating the right in-house processes , and devising and updating the right in-house processes , and giving staff the right tools to do the job. giving staff the right tools to do the job. External influences , such as local market competition, and public or private health quality initiatives and standards also have an impact. External influences , such as local market competition, and public or private health quality initiatives and standards also have an impact. 19

20. Quality team tasks Quality team tasks

21. Challenges Challenges 21

22. Key challenges Before the First Accreditation Key challenges Before the First Accreditation A- The main challenge was the staff resistance to change especially: A- The main challenge was the staff resistance to change especially: 1) To Teamwork: volleyball team not a golf team. 1) To Teamwork: volleyball team not a golf team. 2) To be System managers. 2) To be System managers. 3) To Develop standard procedures. 3) To Develop standard procedures. 4) To Deliver care as an integrated team. 4) To Deliver care as an integrated team. B. Change the concept of physician centered to patient centered care. B. Change the concept of physician centered to patient centered care. C. Accepting the idea of continuous performance evaluation . C. Accepting the idea of continuous performance evaluation . 22

23. D. Staff Turnover due to the fact: Preparing for accreditation and delivering optimum quality of care required more effort at work D. Staff Turnover due to the fact: Preparing for accreditation and delivering optimum quality of care required more effort at work E. Staff Communication especially among physicians. It was noticed that patients managed by more than one specialty their steps of care could be inappropriate due to lack of communication. E. Staff Communication especially among physicians. It was noticed that patients managed by more than one specialty their steps of care could be inappropriate due to lack of communication. . . Key challenges Before Accreditation 23

24. 2005 - 2008 2008 -2011 2011- 2014

25. Accreditation Rewards Accreditation Rewards 25 Clients are more satisfied Larger share of the market Clients are more satisfied Larger share of the market Pride of the employees in their workplace Retention of excellent human resources Pride of the employees in their workplace Retention of excellent human resources Safer environment Less risk less liability Safer environment Less risk less liability Quality culture Continuous improvement Quality culture Continuous improvement Efficient operations Cost savings increased profitability Efficient operations Cost savings increased profitability

26. After the First Accreditation After the First Accreditation Before 2008 JCI accreditation, there were challenges mainly in the form of reluctance of staff to comply fully to the standards. Before 2008 JCI accreditation, there were challenges mainly in the form of reluctance of staff to comply fully to the standards. Action Taken By the hospital Action Taken By the hospital Engaging and empowering the staff Engaging and empowering the staff Stressing on the importance of continuous quality management Stressing on the importance of continuous quality management Regular Quality meetings for all the hospital staff demonstrating areas of good practice and areas that require improvement Regular Quality meetings for all the hospital staff demonstrating areas of good practice and areas that require improvement

27. We found 10 Success Characteristics that are associated with high performance We found 10 Success Characteristics that are associated with high performance 1. Strong Leadership 2. Great Organizational Support 3. Focus on Staff (Professionals) 4. Education and Training of Staff 5. Interdependence of Care Team 6. Performance Result Focused 7. Process Improvement Focused 8. Patient-Centered (Patient Focus) 9. Community and Market Focus 10. Information & Information Technology Orientation 27

28. Take Home Message Take Home Message

29. We learned over the 15 years We learned over the 15 years Keys to Success Keys to Success Leadership Support Leadership Support Start small; use several tests of change Start small; use several tests of change Involve staff to obtain their buy-in Involve staff to obtain their buy-in Make it a win-win situation Make it a win-win situation Reward and recognize staff for their input Reward and recognize staff for their input Provide ongoing feedback Provide ongoing feedback Always make patient safety the priority! Always make patient safety the priority! Never give up; there is no obstacle that cannot be overcome!!! Never give up; there is no obstacle that cannot be overcome!!!

31. Thank You Thank You