Nathan: Hello Dr Abdelghany, it is a pleasure to meet you. I would like to learn more about you and what drives you. My first question is, what do you enjoy about being CEO of Al Zahra Hospital, UAE?
Dr Abdelghany: Hello Nathan, I’m very passionate about healthcare. I mean, even in primary school I thought of myself only as a doctor, I never thought of myself as anything else. So, it was my passion from the beginning to go into healthcare – saving lives, working with patients – I always dreamed of this white coat. Even though I’m only doing a little clinical work, (you can see my white coat on the side), I still maintain my license, it’s important to me that I remain a medical doctor in order to help others. I was an anaesthesiologist for 25 years – but the interesting part was when I made the transition towards healthcare management and business because I was just pushed to do some preparation for opening the hospital, along with the team, which really opened my eyes into ‘oh, there is a completely different way of helping people’.
Nathan: So it clicked that hospital management can still be healthcare and you can keep to your life mission?
Dr Abdelghany: Exactly, instead of helping one patient at a time, as a hospital leader you can help a whole hospital of patients or assist patients through management not just clinically. I then started thinking; ‘oh, how I see it as a doctor is much different from how the management and business people see it’. These differences in preparing and commissioning, budgeting and licensing and getting things up and running was just a huge eye opener for me and got me thinking I should take action. So I got myself trained and educated and got myself a Master’s Degree in healthcare management from a reputable Academic entity and worked towards many other prestigious leadership and financial certificates just to be able to cope with that work in a whole new and different world. I then started running hospitals and healthcare innovations. In these fields I felt that I could gain personal satisfaction and bridge the gap between the clinical component and the business component.
Because I am a Doctor when I talk to Doctors – I understand their pain points, I try to resolve things their way. However, when it comes to budget constraints, I have to explain to them that, yes, we cannot have an open world of, let’s say supplies; you have to be selective between two or three items. If every one of you came and said I need one item, the hospital will never be able to provide it for you – so let’s sit together and agree on what we achieve within budget. These types of dialogues bridge the gap between the two worlds of management of healthcare and delivery of healthcare, it helped me a great deal and it became my passion to jump between here and there.
The second thing is that I’m in a very passionate about quality in healthcare, and these issues need to be addressed at the systematic level rather than on individual initiatives or efforts. So that’s why I joined the Joint Commission International (JCI) as a physician consultant. Wearing my second hat, working for JCI we visit and consult hospitals for the global improvement of patient safety and quality. We’re a team of around 60 people who consult across the globe from Europe to the Middle East to the US and other parts. We work to help the healthcare providers improve their health systems and that is also very good learning for me as well.
Nathan: So as a summary, in terms of how you see role as the CEO – it’s the ability to think like a Doctor and act like a business leader to help thousands of patients ?
Dr Abdelghany: Yes, my personal values help patients get back to their normal lives as soon as possible. The CEO role is challenging because you’re responsible to manage the bottom line and deliver a very high level of quality and patient safety. You have to balance it, which is a day-to-day challenge, however, it does make it exciting.
Nathan: What do you see Al Zahra is being famous for, for example, people go to the hospital because of ?
Dr Abdelghany: This is something that is very important because guiding statements are not just statements or words. The best thing about it is that when you really touch upon it – you feel it, the team feels it, and you really go in that direction. So we put together our vision to become the regional leader, we want leadership in clinical outcomes, because that’s what we do, and we achieve good clinical outcomes. Patient experience complements what we do, because if you have good clinical outcomes but poor patient experience, you’ll be looked at very technically – but it’s a holistic experience – it’s a patient centered approach.
Nathan: Yeah, the operation might have gone well but the patient wasn’t happy, so they don’t come back.
Dr Abdelghany: It’s like when you go into a flight; so you had a good flight but the end experience from the beginning to the time you took your luggage and left – you suffered. So, you reach your destination, you’ve achieved the core function, but you have to make everything around that experience as high quality as possible. So it’s leadership, clinical outcome and patient experience to enhance their quality of life.
Nathan: So really it’s a physical health and mental health (their feelings) that you’re considering?
Dr Abdelghany: Exactly. We’ve got this strategy for five years to try to establish that. From 2016 to 2020 we had that strategy, We have gone so far in our clinical outcomes and our patient experience. We have been accredited with a centre of excellence for the hospital as a whole, but we also have centers of excellence within the hospital which helps us achieve our remarkable clinical outcomes that can be benchmarked globally. So when we say, a centre of excellence – the outcomes of this are benchmarked with the best places globally. We have for example, orthopedics and sports injury, we have joint replacement, we have obesity surgery. As we are currently review our 2021 strategy, our main addition will be adopting to the digital transformation in the best way that serves our patient experience and clinical outcome. And we are preparing for this from now by partnering with different providers and governmental in terms of telemedicine and telehealth.
Nathan: I heard that Al Zahra recently 3D printed and then performed a successful knee replacement surgery? Yes, we have the expertise of over 35 years in joint replacement by world class surgeons in the MENA region. We are proud to have Dr. Sameh Tarbichi in our team who was one of the pioneers to introduce the 3D custom-made implants in the UAE, which made a breakthrough in enhancing the quality of life of our patients. These custom-made implants adjust to the bio-variations of the Middle Eastern patients who are very different compared to the European patients for instance by offering patients a comprehensive treatment that suits their unique lifestyle. These implants also offer better solutions for patients with uncommon body types, high deformities and traumas. In addition to that, we now have two accredited centers of excellence in cardiology and oncology where we offer great services.
Dr Abdelghany: Yes,
Nathan: Oncology is a big opportunity because it is underserved in the region.
Dr Abdelghany: Exactly, our oncology strategy was not selected out of the blue, it was selected based on a huge strategy and a market assessment and supply and demand caps. Our detailed studies have identified that these would be our centres of excellence along with gastroenterology, this is where we establish our clinical outcomes. On the patient experience front, we have made many advances in our patient systems, for example a patient engagement program where the patients journey is mapped onto an app. We are even trying hospital check-in through a kiosk with facial recognition. At the moment, when you step into the hospital you don’t need to go to check-in counters, just go straight to the service point. Initially we will bridge it with a barcode kiosk reader so you will need to check-in, then, a mobile payment process, then if the doctor gave you a prescription – you will know how long to wait for the prescription and approval process, it is all seamless in this app. The experience itself makes you feel comfortable. When you go home and you need to repeat medication, you get a reminder, you will be notified when you lab test is ready, if an image is there then you will receive it without having to ask.
Nathan: Lack of compliance with medication is every healthcare providers biggest challenge.
Dr Abdelghany: Absolutely, that’s why we send out reminders for medication because most of the patients do not comply with their medication and that prolongs the treatment and affects the desired outcomes.
Nathan: so strategically that actually helps the hospital and the patient?
Dr Abdelghany: Absolutely. This app makes you connected to the hospital and its doctors. You can even communicate with your clinician through a secure WhatsApp.
Nathan: So, the technological advancements actually come back to the reason you wanted to be a CEO – to help multiple people with multiple systems through the use of technology?
Dr Abdelghany: Exactly, because you can have a very good doctor or nurse who can communicate very well, but sometimes they can be under pressure or overloaded. You need to be able to facilitate patients with tools that enable them to do this sustainably. This can satisfy patients so that they don’t have to call ten times to get their lab test, it also reduces the amount of calls the doctors receive and their stress as well as they can have more face time with patients. Face time will be at the core of healthcare for a long time.
Nathan: so the technology is actually allowing more human time and less administration time.
Dr Abdelghany: Exactly. They don’t want machines.
Nathan: and if the doctor doesn’t have to think about all these things and can focus, they will have a better patient experience.
Dr Abdelghany: Yes, we need to have more valuable face time. Comfort, face time, value time – this is what we want to increase using technology.
Nathan: What do you think is the primary challenge to implementing a lot of these digital strategies?
I think the primary challenge is usually the cost. Implementing technological systems usually costs a fortune, not only to acquire but also to maintain. However, the benefits it reaps are indispensable especially when it comes to patient safety and enhancing patient experience. For instance, AZHD has recently bought a state of the art high tech MRI and ultrasound systems equipped with AI to provide accurate diagnostic support to its different current and future certified Centers of Excellence in AZHD such as orthopedics and sports injuries, bariatrics and metabolic surgery, minimally invasive gynecology, oncology and cardiology in a major step to pursue our vision of leading the region in clinical outcome and patient experience. By adopting Siemens Healthineers’ newly released Acuson Sequoia ultrasound system with its higher penetration capabilities, the hospital is now equipped to accurately diagnose patients with larger body types.
Overcoming the aversion to change is another major challenge. In the lifecycle of any innovation, this is to be expected. However, for a modern healthcare business, letting aversion to change win out over good sense can be devastating to our vision of clinical outcome and jeopardize our patient experience.
Nathan: it’s a market response as well isn’t it? You’re listening to people.
Yes, definitely! As I mentioned, our vision was focused on clinical outcomes and patient experience. As we move on, the digital transformation is progressing across different industries. We realized that we have to have an element of digital transformation in order for these two major objectives to be achieved. So, we started to examine digital transformation and are able to see the impact of digital transformation happening in other industries. So, we tried to develop our digital transformation strategy to be launched from 2020 – we should have a digital transformation strategy for at least 5, if not 10, years. We realised that, as a team, we will work on the strategy with some partners from outside and including areas that are growing but are still not taken as an integrated program. We felt that if you tried to address. ‘where can artificial intelligence help us in healthcare? Where can mobile apps like our patient app. help us in healthcare? Where can telemedicine, or teleradiology or telepathology help us in healthcare? But that entailed that first we need to understand how these are offered, what is the best platform to use, how can we manage the change within the organisation and the delivery model, because our delivery model will change eventually. More importantly we realise that this can’t happen as a fragment without a proper strategy and integrating all this so that we can arrive at the digital transformation. This is where we started thinking about digitalising some of what we do, how we are putting it, what is our time frame, how we manage the change, the training of the staff, the interface with the community and the interface with the reimbursement and the regulators. There is a 360 look around, all of this which is coming now in the form of our new digital transformation.
The first outcome will be the patient mobile app, the second will become our newly launched program. We are launching a program that works across telehealth; telemedicine and teleconsultation means that patients can be consulted remotely; even if they’re sitting in the UK, we can still consult with them. And then telepathology – we can exchange the reports – we can even get the histopath through our histopathology digitaliser to read the slides utilising artificial intelligence so you get accuracy of above 90% and the remaining 10% will be for the humans (pathologists) to interpret.
Nathan: it allows the pathologist to concentrate on the difficult ones where as the easy initial readings can be done by AI.
Dr Abdelghany: Exactly, he is not here to waste his time doing the easy part, the easy part can be done by the machine as it learns.
Nathan: So it’s to free up the humans as well?
Dr Abdelghany: Yes, freeing the humans to do more valuable work as we have been discussing. The same situation in tele- radiology, we can have a platform wherein we would need a particular number of radiologists (because radiologists themselves are a very scarce commodity). I mean, every day we do more than 300-400 scans, between ultrasound, traditional and conventional radiology, CT, MRIs and others, this is a huge number. You can never have enough talented healthcare professionals. So, you need to work with platforms where those who have excess capacity of radiologists can help you with this, and when you have excess capacity – you can help them. It’s similar to the tele-consultation model.
Nathan: and the timing of the day as well isn’t it?
Dr Abdelghany: You’re sharing the resources, night-time for me, it’s morning for the US, so we can benefit from this. We need to share the resources so that none of us are sitting idle.
Nathan: because patients don’t just break bones during the day!
Dr Abdelghany: Yes exactly, all times of the day,24-7-365. For many cases we don’t need to see the patients physically to do things with them especially for chronic diseases.
Nathan: which also helps patient experience because travelling and the stress of the road… even before coming to the hospital they are stressed, so you’re thinking about even their journey to the hospital.
Dr Abdelghany: Some studies show that more than 60-65% of patients who come to hospitals do not need physical review. The Internet of Medical Things (IoMT) comes to provide the telemonitoring devices for blood pressure, blood glucose and other required parameters such as heart rate and even ECG then you have a reliable system, that can connect to your doctors and your electronic health records. You can do plenty of things by observing, then you can advise the patients if you need to intervene or they need a hospital visit, you can even consult them and tele prescribe the medicines for them. So, this is a completely new way of delivering healthcare.
Nathan: and there’s an audit trail as well.
Dr Abdelghany: Absolutely there is an audit trail.
Nathan: and with the DRGs changes coming through.
Dr Abdelghany: Now with the DRG coming, you need to do more with less. You need to do much much more with less cost. The way the costs are growing, not only here, but globally for healthcare, is truly unsustainable. Its skyrocketing and then if you look at it in the US, it’s eating almost 20% of the US GDP, the largest global economy.
Nathan: and unfortunately, the trajectory of obesity is following the US trajectory of obesity there and the ramifications are going on for chronic diseases, so there is almost a pattern that you can look at.
Dr Abdelghany: In the UAE we’re seeing more juniors becoming obese than we saw in the last decade. Obesity is increasing, one of the largest incidences globally, and, more dangerously, that it is seen in younger generations. There are many different approaches but if you just initially approach all young people and their families in their locations and using technology, in the community and in schools giving them ongoing support, education and advice on lifestyle choices, diet and exercise modified to suit the individual, the outcome will be that early intervention, or if possible prevention of obesity or associated medical conditions, which is much better than cure. If a patient comes here with complicated diabetes going to ICU, it doesn’t only cost the patient huge suffering and personal complications for him and his family, it is also very costly for the system. If you are able to prevent this early on by using an integrated program, relying on technology, training your teams to handle it – I think that’s good for everyone and ultimately good for the hospitals because we leave the spaces for the people who really need them.
Nathan: So the digitalisation of the hospital has a wider impact on the healthcare benefits of the society even at home, so its not just the hospital being digitalised but the outreach as well that is benefitting.
Dr Abdelghany: It’s the system as a whole. Where the patients live is where the digitalisation should be happening. Patients do access everything now through their mobile, except health, it is my vision, personally that they should be able to access 80% of what they do through their mobile and the remaining 20% can be managed much better in the organisation – better face time, better value, right selection of patients and good impact on outcomes.
Nathan: how and why did you select Ver2?
Dr Abdelghany: I like the way Brian started to think about this because he thinks in a very similar fashion to us but from a provider perspective. We are a user of a system, we cannot invent a platform, he already has a platform, he developed this platform. The platform has a telemedicine platform, teleradiology platform, telepathology platform, teleconsultation platform, telemonitoring platform. He has these different platforms, so that you don’t need to do things from scratch, you need to have a trusted partner who has this technology but you need to tap into this technology modifying it to patients needs and then training and endorsing and managing the change in the team. We also need to partner together to address both sides, because there are challenges for him and challenges for us to put that program together; we also need the regulators and the other partners and insurance companies on board because that will help us reduce the cost. So instead of having a consultation of ‘x’ amount – we can have it at half the cost. But we need to engage them more. So, we are partnering with Ver2 to develop our digital strategy to start implementing it effectively in 2020, we have selected them based on their experience in that field and the platforms they have. I like their platforms, they have a platform for education as well which is something very important.
We have another platform for multidisciplinary team meetings, we have a tumour board every week who meet to discuss all cancer cases. This team comes, not only from AI Zahra hospital but all other private hospitals in the area, sometimes they come regionally, sometimes we connect to people in the UK and the US. If we have this platform for communication this is secured real time and facilitates better global discussion and engagement. We can reach the best decision for the patients, sometimes we need to tap into some very highly specialised areas, we don’t need to bring the clinicians here we can use the platform.
Nathan: it comes back also to the original question of how and why you see yourself as the CEO – it’s the thought process. I feel as though in terms of the two, Brian had the vision in terms of developing the platform but the thought process where the patients were at the centre. Now actually there’s a lot of tech companies that develop platforms that don’t have the patients at the centre.
Dr Abdelghany: Yes, they are not all patient centred and don’t have this focus on how the patients will be more comfortable here. This is the alignment that we have and this is why we have particular partnerships.
Nathan: So it’s the human mind and the technology together – I understand.
Dr Abdelghany: Yes, our natural intelligence along with our artificial intelligence that works together, yes.
Nathan: It all links together, I think that’s part of the success you’ve had is that it comes from your good values and I think that over a long period of time, values are congruent, and it comes through behaviour.
Dr Abdelghany: In screening for selection, we screen our candidates again for these values. This comes even in the interview for clinician, doctor, administrator or nurses, the value system should be there. Throughout our orientation process and on boarding journey we reward values, respect, excellence in quality and patient safety, we also reward learning organisation, achievement of good patient experience and safe delivery of care.
Nathan: I saw it in the café with the employees.
Dr Abdelghany: Yes, it is called RESULT. This is AI Zahra’s gene! This is what makes Al- Zahra different and unique – that everyone lives these values, especially when things are vague or not so clear then the value system comes into place.
Nathan: because it’s the default. Under stress people default to their natural values because they’re not working on protocol – they’re working on instinct -and the instinct is values.
Dr Abdelghany: Exactly, these values along with the vision, once they’re put together – they link this hospital to where it is now as a leading hospital in Dubai. So we’re proud of this accomplishment, in terms of our year to year growth, our patient mix which is becoming very complex, (we do almost every complex surgical speciality in the hospital) and then our positive quality and safe outcomes which are a reflection of our strong values. So this is how we are very happy adopting this clear, unambiguous vision and value systems.
Nathan: I understand. The body behaves how the mind thinks. The body is the hospital and you and the management team are the mind.
Dr Abdelghany: Yes exactly! I would like to conclude that it is a privilege and honour to serve our patients alongside the caring and talented healthcare team at Al Zahra Hospital.
Nathan: Thank you very much!
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