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Saudi Arabia 2019-2020 | HEALTH & EDUCATION | VIP INTERVIEW

TBY talks to Dr. Fahad S. Al Ghofaili, CEO of King Fahad Medical City (KFMC), on the need for preventative measures for a healthier population, its vision for the applications of technology for healthcare, and its goals for the short term.

KFMC has grown to become one of the leading tertiary care facilities, now within the Riyadh Second Healthcare Cluster. What opportunities are there to increase efficiency and better serve patients in the new structure?
The concept of a “cluster" is a population-based entity, serving some 1.5-3 million people, rather than a specific geographical area or location. We are moving from the previous service-centered approach toward implementing a patient-centered approach. Within the clusters, all levels of care are provided: primary, secondary and advanced care. The system is driven by outcomes so patients have easy access to consistent quality and efficient care. We are empowering primary healthcare centers to take the lead in providing all primary and chronic care, which will offload the tertiary care centers. This care will be provided at the new and revamped primary care facilities, allowing them to act as the vendor for triaging and referral to specialist care. Primary healthcare will be the hub for all access to care, which is a major transformation—in fact, it should deliver around 60% of total healthcare provided. The grand vision is to have a healthier population and increase the life expectancy from the current 72 to 80 by 2030. This requires, aside from adequate healthcare, a large number of preventative measures, for which we are launching awareness campaigns, recruiting health coaches, and addressing chronic diseases from their inception rather than dealing with the complications later. This approach enables patients to become more proactive and to take ownership of their personal health rather than react to complications that need to be dealt with at a higher level or crisis managed. There are some gaps in the healthcare system and budget constraints, which allows for more public-private collaboration. For us, it is not for the purpose of generating revenue, but rather to close these gaps. We still need to set our quality measures and KPIs, which all healthcare providers are obliged to follow; good performers will be incentivized, outstanding performers will be rewarded, and underperformers will be guided.

How do you envision enhancing the provision of how trauma care?
Trauma is fragmented today, which is why it is not yet on par globally. In fact, trauma is the leading cause of death in Saudi Arabia for the younger population. In other countries, the leading cause of death is cancer, chronic diseases, with trauma holding between fifth and 10th place. Therefore, it is one of our three primary focuses on the level of our national programs along with stroke and coronary disease. We require an integrated efficient system that will provide a high level of trauma service—high alert, quick access, and adequate post trauma care. Today, we do not have long-term care facilities, and there is a shortage of rehabilitation hospitals. One can provide acute care for trauma cases, though unfortunately some require long-term care including rehab services. It has to be a comprehensive care from start to finish with the concept of integrated practice units (IPUs)— from the moment a patient is placed in the ambulance all the way through the necessary levels of care, inclusive of rehabilitation services such as physiotherapy. Currently, the waiting list is six months long for a rehabilitation hospital and two years for a long-term care facility. We are currently working on an initiative to build a rehabilitation hospital with 400 beds, involving a private investor, with which we recently signed a contract. This model is an excellent alternative, as undertaking a venture of this magnitude without an investor would not be possible. It would drain the resources needed for acute care.

What is your vision on the application of telemedicine, both for consultations and long-distance treatment, and on using technology for advanced medical care in general?
The country's healthcare administration has realized that without investing in e-health, we will have redundancy in the system, so it is certainly a priority for all stakeholders involved. Today, we are understaffed in terms of ICU and oncology physicians for which there is big demand. Therefore, it would be impossible to establish such a tertiary care center somewhere in the north of the Kingdom, though we can strive to provide a similar service utilizing technology: telemedicine, tele-ICU, tele-emergency, and tele-oncology. KFMC has initiated a teleclinic with a partner in the north, currently covering four services on a weekly basis: cardiology, oncology, ICU, and pediatrics. Patients can communicate with a physician, while there is a robot programmed for that as well. Telemedicine has been tested globally in the past 10 years and has proven its value aimed at patient care, cost accounting, and high quality. We are ready to go beyond the pilot stage, and our next step is the rollout of all-encompassing telehealth.

What are the primary ambitions for the coming years?
When we shared our experience with the other clusters, we realized we had many of the same issues in common. There is a robust infrastructure in place, but a large gap between the primary care system level of care provided and the services delivered at the tertiary level, which are in great demand. The coming three years are therefore dedicated to building a robust primary healthcare system. This will offload our outpatient departments by 20%, and we should be able to cut our waiting lists by 25%. At the same time, we can provide specialized chronic care in the primary healthcare setting. In terms of financial management, we strive to develop a better data collection and data banking system to enable us to utilize a more transparent method of calculating costs. Over the last 10 years, we have invested heavily in certain disease groups, and we have become proficient in neuroscience, cardiac care, and oncology. Before committing and making new investments in specific areas, we need to have our value-based healthcare system and integrated practice units in place. A patient should be comfortable knowing that when he comes for heart surgery, he will be taken care of from the moment he is admitted to the hospital until he is discharged with the desired outcome.