LEAN MACHINE

Oman 2018 | HEALTH & EDUCATION | INTERVIEW

TBY talks to Dr. Qasem Bin Ahmed Al-Salmi, Director General of the Royal Hospital, on the hospital's growth, lean management success, and qualified Omani personnel.

Dr. Qasem Bin Ahmed Al-Salmi
BIOGRAPHY
Dr. Qasem Bin Ahmed Al-Salmi has served as Director General of the Royal Hospital since 2010. He has overseen the launch of several specialty centers at the hospital, including the National Diabetes and Endocrine Centre, National Genetics Centre, and Molecular Imaging Centre. Through the opening of new clinics, adding a maternity and pediatric ward, promoting daycare, and introducing many new measures to increase efficiency, the hospital has increased throughout by over 100% under his leadership. In addition to his role as Director General, Dr. Al-Salmi is also a senior consultant for the Pediatric Pulmonology Unit at the Royal Hospital.

In light of celebrating 30 years in 2017, how has the hospital and Ministry of Health evolved to reach this important milestone?

The Royal Hospital was commissioned in 1987. Built by Wimpey-Alawi LLC with the intense involvement of Omani leaders of the medical profession, the structure set a benchmark in hospital planning and design and became a model to be replicated in all regions of the country. Being the main healthcare provider, and blessed with a wise and stable leadership and support of the Ministry of Health, the hospital was able to lay out a strong network of primary, secondary, and tertiary healthcare institutions and implement a referral system. This helped the Royal Hospital to transform itself from a state-of-art district hospital to an acute-care, tertiary-level apex referral center serving all regions of the country. And over the last two and half decades, the ministry has consistently provided resources to enable the Royal Hospital to upgrade its technology in step with leading hospitals in the developed world. The Royal Hospital also fulfills the role of a secondary-care hospital for Muscat as well as the major teaching hospital for the Sultan Qaboos University College of Medicine, Oman Medical Specialty Board post-graduate residency program, nursing institutes, and other allied health courses. Over the years, the Royal Hospital has expanded, specialized, and strived for centers of excellence to manage non-communicable diseases highly prevalent in Oman. Thus, many specialty centers were established. The Hyperbaric Medicine Centre is the latest addition, which is in the process of being commissioned. Also, 2016 was significant in terms of another significant milestone: the Medical Laboratory achieved ISO accreditation in August, and the Hospital attained recognition by Accreditation Canada International in December.

To what extent have recent liquidity issues impacted the Omani healthcare system?

While the economic downturn caused by the low price of crude oil has negatively impacted development projects, this period has given the Royal Hospital and the Ministry of Health a golden opportunity to search for more cost-effective ways of delivering healthcare. Several strategies were deployed to improve efficiency and reduce system waste. Besides making the staff more patient-focused, applying these concepts has achieved encouraging results. As an example, in the Adult Emergency Department, 55% of patients had a turnaround time of more than four hours in 2015. Currently, no more than 8-10% of patients wait more than four hours before getting admitted or discharged. Buoyed by this success, the hospital has now set up a performance improvement unit and another training program is being organized. So the need to “tighten the belt" during this period of economic uncertainty has been a driving force for government healthcare facilities to review their efficiency in resource utilization, achieve higher targets, find ways to minimize waste, and set up key performance indicators to benchmark and improve performance.

How has the policy of Omanization developed in the healthcare sector, and how qualified is current local personnel?

As the policy of Omanization was actively promoted since the early years, all heads of departments and clinical units, most of the senior doctors, the nursing administration, heads of nursing units and wards, and all senior technologists at the Royal Hospital are Omani. This is true even for highly specialized areas like cardiology and cardiac surgery, interventional cardiology and radiology, nuclear medicine, minimally invasive surgery, medical and radiation oncology, neonatology, pediatric intensive care, pediatric nephrology, pediatric and adult gastroenterology, pulmonology, and endocrinology. After their residency program in Oman, most doctors have obtained fellowship degrees from the UK, Canada, or the US, and have undergone advanced subspecialty training at leading centers abroad. So the Royal Hospital has not experienced any drop in throughput, quality of care, or level of sophistication in clinical procedures after the departure of expatriate doctors. Furthermore, since most consultant positions in capital area hospitals are filled, after advanced training abroad, Omani doctors are now returning to regional hospitals, too.