Forecasting the Future of Health Care: Challenges and Opportunities for Leaders in Risk Management

1. Forecasting the Future of Health Care:Challenges and Opportunities for Leaders in Risk Management MedHealth 2013

2. Content • Common healthcare challenges • Qatar’s health system • Evidence on current and emerging risks • Challenges and opportunities for risk managers – a perspective from Hamad Medical Corporation

3. Countries around the world face similar healthcare challenges Technologically empowered customers Equal Access for equal need New Science / Personalised Treatments Ageing Population Chronic Illness Expectations for Quality Care Patient-Centric System Rising Costs Health Policy Reform

4. Healthcare Wellness Care is shifting towards personalisation throughout the healthcare system Healthcare Yesterday’s System Wellness Healthy Prevention Vulnerable Prediction Sick Affected Prognosis Today’s System

5. A pen picture of Qatar The extraordinary population boom is set to continue • Population • In ten years population grown from 740,000 to 1,900,000 • Much of the growth is in the expatriate workforce from South and South East Asia, MENA, Europe and North America • 75% of the population is male due to the imported workforce • The population is also overwhelming of working age • Nearly half of the population live in the capital city Doha • With the growth in the economy and large infrastructure projects, the population will continue to increase rapidly (2.4m by 2030)

6. Health challenges Our overall challenge is to transition from a health system that treats acute patients, to being one that predicts and prevents ill health, particularly for chronic and lifestyle diseases, with high quality acute and tertiary care for those patients that need it. • The diversity of the population means that we suffer from a double burden of disease – communicable diseases associated with the developing world and those associated with modern lifestyles in developed countries • Some of the greatest burden of disease in the population is from chronic diseases, including metabolic diseases, obesity, cardiovascular and hypertension, and respiratory diseases such as asthma. • There is a particularly high incidence of diabetes at 16-17% of the adult population • The incidence of cancer is not high but is expected to grow as the comparatively young population ages and grows, and that is being addressed through a new and comprehensive national cancer strategy • Similarly, there is a new mental health strategy which will seek to build primary and community services rather than relying too heavily on inpatient models of care • Qatar also faces the challenge of high rates of trauma injuries, with road traffic accidents and work related injuries accounting for a large proportion of cases

7. National Health Strategy – Model of Care

8. Hamad Medical Corporation (HMC) Embarking on one of the most ambitious master facility plans ever seen in international healthcare Only public provider outside US with all hospitals accredited by the Joint Commission International. Established the first Center for Healthcare Improvement in the Arab world. • State funded national provider • Provides 90% of acute services in Qatar • Large employer with c.20,000 staff and a diverse, multi-national workforce • Manages eight general and specialist hospitals with over 2000 beds and the ambulance service • 3 new hospitals opening in 2014 • Aims to be internationally recognized integrated healthcare system acclaimed for excellence in healthcare, education and research

9. Growth in population significantly outpaces growth in our bed numbers Note: Bed numbers and population indexed to a value of 1 in 1957; Health expenditure (derived from World Bank data) indexed to be equal to bed numbers in 1995

10. A Fast Developing System under Pressure

11. Evidence from Patient Safety Research “At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented.” - US Institute of Medicine, November 1999 “Unsafe patient care is common and associated with significant morbidity and mortality throughout the world… much of the harm is likely amenable to intervention. Studies from the US suggest that approximately 3% to 4% of hospitalized patients suffer a serious adverse event. Studies from other developed nations found that between 8% and 16% of hospitalized patients suffered an adverse event. Between 30% and 50% of such adverse events are preventable.” - A.K. Jha et al, Quality and Safety in Healthcare, 2010

12. Types of Errors The Quality of Health Care in America Committee of the Institute of Medicine (IOM) concluded that it is not acceptable for patients to be harmed by the health care system that is supposed to offer healing and comfort--a system that promises, “First, do no harm.”

13. Systemic migration to boundaries

14. Hamad Medical Corporation Vision To be an internationally recognized integrated healthcare system acclaimed for excellence in healthcare, education and research and play a premier role in the sustainability of health in Qatar. Unifying Purpose To deliver safe and effective health care and the best possible experience for every patient.

15. Hamad Medical Corporation

16. A Risk is……….. ……..the chance of anything happening that would have a negative impact upon our ability to deliver our strategic objectives and our vision for health care

17. Good risk management is important because it….. • Ensures the organization is aware of its strategic risks i.e. those which have the greatest impact on its ability to deliver its strategic objectives • Ensures the organization has a plan for managing those risks • Minimises the impact of the risks to a level which is acceptable i.e. risk appetite • Provides individuals and departments with a framework for reporting risks • Underpins essential culture change in the organisation

18. Error reduction Overview: Hierarchy of Controls Mitigate Human Factors Facilitate Eliminate Standardization & Simplification

19. Types of Culture

20. The Required Culture Change