His Excellency the Minister of Health, Dr. Abdullah Bin AbdulAziz Al-Rabeeah, emphasized the significance of the implementation of heightening quality and improving patient safety at all health facilities all over the Kingdom, pointing out that such services are of top priority for the Ministry as it's reckoned one of its central strategies. “He stressed that the Ministry will do its best in order to provide all what citizens need and aspire to,” stated the MOH’s Official Spokesman, Dr. Khalid Marglani.
Dr. Khalid Marglani added that the Minister follows up the implementation of safety and quality programs as well as the projects for improving and upgrading medical performance; in an effort to reach the high-quality level of medical services provided to patients. He clarified that the Ministry has carried out several programs within the framework of the National Project for Integrated and Comprehensive Health Care; especially with regard to enhancing the medical performance and improving its outputs.
Improving MOH facilities' performance, especially in intensive care units and operation rooms
Dr. Marglani indicated that the Ministry has adopted a group of productivity and patient safety developmental programs in its facilities. For example, the Ministry has established several developmental patient safety programs in operation rooms, neonatal intensive care units (NICU), and geriatric intensive-care units in hospitals; especially in the path of improving medical performance in intensive care units for newborns “neonatal intensive care units (NICU)” as it has been positively manifested in a lot of hospitals; which has been finally applied in cooperation with the University of Minnesota. It was initiated with a comprehensive screening survey for NICUs. Under the first stage, the program was applied in (4) hospitals; whereas for this year, the program is applied in (14) hospitals. Furthermore, the Ministry has improved neonatal services, delivery rooms and obstetrics and gynecology units in (9) hospitals all over the Kingdom, as well as implementing programs for improving pediatric intensive care units.
As for improving the performance of geriatric intensive-care units, it has been implemented in four hospitals in Riyadh as a first stage; through which measurable standards have been strictly embraced to meet the aspired achievements. Currently, preparations are underway to implement this program in Jeddah, Dammam and then all regions of the Kingdom. Regarding the path for improving productivity in operation rooms in hospitals, it has been implemented in (20) MOH hospitals. That contributed to promoting productivity in operation rooms by 25%.
Implanting Quality Culture
Dr. Marglani indicated the quality culture has been witnessing and ever-increasing growth. It has created, thereby, a specific route to be pursued and applied by employees in MOH and all of its facilities. Also, the MOH implemented surgical monitoring and analysis program in hospitals; which is an electronic system developed by the American College of Surgeons, through which the analysis of surgical operations is carried out, and the extent of success and complications are determined, in order to compare the performance of hospitals and surgeons working at those hospitals.
In addition, the Ministry has established a health risk program, through which each specialized physician in each hospital has been trained to follow up, study and benefit from any potential health risk on the patient. Also, each specialized pharmacist in each hospital has been trained to follow up the implementation of drug safety guidelines, and educate doctors and nursing staff about the optimal way to prescribe drugs, probable medical errors and ways to avoid them. That was achieved by establishing a medical safety program.
Moreover, a committee has been formed for verifying of certificates and approving clinical practice, whereupon physicians' certificates have been verified, and they wre granted clinical privileges depending on their medical qualifications and skills; in order to insure that doctors would not operate surgeries beyond their qualifications or skills, or beyond the scope of their respective specialty. This procedure is implemented in all hospitals around the world; and it is implemented by MOH for the first time.
Hospital Accreditation Program
Dr. Marglani stated that 50 of the MOH hospitals have obtained the local accreditation certificate of the Central Board for Accreditation of Health Institutions (CBAHI), 17 health facilities have attained the accreditation of the Joint Commission International (JCI) Accreditation Standards for Hospitals, whereas the JCI accreditation of 13 hospitals is still underway. Also, 40 hospitals are to be locally accredited in the next stage.
Medical Staff Bylaws Guide
Within the framework of the keen interest shown towards health services providers, the Ministry has adopted a set of work discipline rules for medical staff, known as “Medical Staff Bylaws”. In this guide, the designated role of the physicians and their responsibilities towards their patients are clarified. It gives an elaborate account of the method to record in the patient’s medical file; and explains patient’s rights imperative to be followed, as well as practices. In addition, the guide clarifies the method applied for promoting doctors, approving the clinical privileges and evaluating their surgical skills as well as their practical and scientific qualifications. Thus, the Ministry has a clear and feasible guide the points out the method of medical practice and rules, which will be one of the most important references to prevent medical errors and promote the service.
Unifying measures and preventing false Judgments
Rules, measures and procedures have been articulated for medical practice, known as the “Administrative Policy and Procedure”. It is a new project introduced to the Ministry for the first time; where all medical practice and other practices policies and measures are stipulated. Through that project, there is a unification of measures and prevention of false judgments by employees working in the hospital whether they were physicians or nurses. A good example can be work ethics of employees, medical file record rules, and patient resuscitation rules. That will enable the Ministry to improve the medical performance in general.
Evaluating performance of hospitals and medical staff
The MOH’s Official Spokesman added that the surgical monitoring and analysis program in hospitals, which was embarked on in 1433H, is an electronic system developed by the American College of Surgeons. It is applied in a lot of hospitals in USA, where the surgical operations results are analyzed, the extent of success and complications is determined, for the purpose of comparing the level of the performance of hospitals and surgeons working there. A team from the American College of Surgeons has arrived in 6 MOH hospitals; they were hired to study the results of all surgical operations carried out in these hospitals. The results were subjected to the same evaluation process conducted in the USA.
It is expected that this program will be a motivation for all hospitals and surgeons to exert their utmost efforts, and insure adopting the highest level possible; in order to guarantee avoiding conducting any surgeries beyond their abilities and specialties. In addition, it will be a great motivation for consultant physicians to showcase their works, researches and productivity by developing a program that enables following up physicians' productivity where all operations and clinics are registered.
Furthermore, the Patient Safety Program has been developed; more than 90 consultant and specialist physicians have been trained on patient safety and how to prevent medical errors. Moreover, in cooperation with the University of Minnesota, the Ministry has trained nursing staff on the most recent nursing and curative care for newborns. Also, the Ministry has come to an agreement with Fetus and Newborn Committee in Canada to use the Premature Birth Follow-up Program.
Patient Safety and Redressing Critical Errors
Dr. Marglani added that medical improvement programs in MOH facilities have, also, included developing a program for recording critical errors taking place at all MOH hospitals, with a view to redressing such errors and registering the defects that might have caused them, such as wrong blood transfusion or conducting a surgery on the wrong organ, or the wrong patient. He clarified that the Ministry is keen on executing the directives of his Excellency the Minister of Health in this regard.
Clinical Audit Program
Dr. Marglani pointed out that this program has greatly increased the awareness level about the importance of measuring and observing the level of health facilities performance, through which 49 clinical indicators are followed up in 90 MOH hospitals, such as deaths resulting from surgical operations, or deaths inside the hospitals and its percentage; in addition to other globally recognized indicators.
Bed Management and One Day Surgeries
It didn't escape Dr. Marglani's notice to shed some light on the need to establish a bed management program, that is necessary for following up bed movement in the Ministry and how to utilize it well; which means serving the most number of patients possible on one bed. Also, the project included developing the one-day surgery program, which managed to improve the percentage of one day surgery from 2% in 1430H to 33% this year in most of MOH hospitals. More than 60 thousand surgeries were carried out in the Ministry by means of the one day surgery method after it had been counted by hundreds in the past.
Improving medical records
Dr. Marglani concluded his statement by clarifying that the Ministry has adopted the Australian Medical Coding System at all health facilities in medical files in order to record and code diseases. In addition, MOH has developed medical files improvement program that aims at unifying medical models in all MOH hospitals in order to make them electronically accessible. Also, MOH has improved all sections of medical records providing them with computers and all necessary devices, training employees working there. Moreover, a program for enhancing the performance in emergency units in hospitals has been developed; it started in Riyadh where it was very successful, and it will be transferred to Jeddah and Dammam, then to all other regions. Furthermore, the Critical Errors Detection Program has been developed and implemented in MOH for the first time. It instantly records every critical error in any hospital, then the hospital is requested to record it electronically on a special computer system designed by the Ministry for this purpose as that helps hospitals and all employees there to look into the occurring critical errors to study how to avoid and prevent them.