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Mon 18 Aug 2008 04:00 AM

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Building blocks

Following last month's look at business planning, Medical Times examines the fundamentals of building and staffing a clinic and discovers the art of constructive criticism.

Following last month's look at business planning, Medical Times examines the fundamentals of building and staffing a clinic and discovers the art of constructive criticism.

Now that you have a business plan in place, it's time to turn theory into reality. Taking the step from speculator to investor is a daunting moment for physicians, so it is vital to hit the ground running. If you are starting a medical facility from scratch, you're about to discover that doing business in an emerging market can bring great rewards.

Great challenges, however, are also a sure-fire certainty. The second part of this series will consider how to navigate the construction and design of your facility, and how to get started with the process of recruitment.

Doctors need to know exactly what it is they are going to be doing, how much they are going to be paid, and what the benefits of the package are.

Seeing red

While development in the Gulf is rapid, the processes behind it are plodding. Moorfields Eye Hospital was one of the first clinics to set up in Dubai Healthcare City (DHCC) and the process was a learning experience, according to the branch's CEO, Dr Chris Canning.

"It is fascinating because it is so varied - there are some things in Dubai that we can do far faster than in England, and then there are some that are so Byzantine that you don't know how to make progress with it."

Canning believes that the Middle East, and Dubai in particular, does have a focus on reducing red tape - but a brief look at the emirate's flagship medical venture, DHCC, shows that there is still a fair amount to reel in.

Dr Mohanakrishnan, director of planning at DHCC-based consultancy firm Eurohealth Group, explains that the first step to setting up in a freezone is to prove you're needed. "If you want to start a medical clinic you have to get approval for the type of clinic you want to open from the Center of Planning and Quality (CPQ) - they have certain buildings designated for certain types of facilities," he states.

Once the CPQ accepts your application in principle, prospective facilities have to submit a provisional design. Guidelines vary across the Middle East, but there is a general move towards adopting the fixed guidelines followed by Joint Commission International (JCI) and the American Institute of Architects (AIA).

These are also the guidelines approved by the CPQ and getting to know them inside and out could save you a lot of time. Nevertheless, you have to be prepared to sit on your hands for at least a few weeks, according to Mohanakrishnan.

"The initial paperwork, getting the design approvals and going back and forth, will take about six weeks," he estimates. Yet this is very much a best-case scenario, as the CPQ needs more than just well-laid plans to give the go-ahead.

"It is not just the construction work as there are a lot of other things," he says. "You have to calculate the electrical load, get the approval from the Dubai Electricity and Water Authority (DEWA), have a fire-fighting system approved by DEWA - they are very strict on the guidelines."

Indeed, getting online with utilities was the most stressful part of the construction process for Moorfields, states Canning. "There are certain restrictions in this town that everyone knows about," he admits. "There is not enough electricity and there is not enough water, so all new buildings get delayed."

Vision of the future

With so much to think about just to get your project off the ground, it can be difficult to see the wood-furnishings for the trees. For most facilities, you only get one real chance at stamping your mark on its appearance.

It is crucial to have a strong design focus from the outset, insists Ferra Sabooni, director of business development (UAE) at science and technology design firm CUH2A.

"Physicians have to pay attention to design, because design is like a signature," she states. "Facilities have to look attractive, especially in an area like the Middle East - if it is pretty, different and exciting then people will go for it."

Having a stand-out design is only half the battle, however. Making sure that contractors produce what is actually on the blueprints is another matter. Sabooni reveals that CUH2A are currently involved in gutting out and redoing a completed healthcare project that had been built to the wrong specifications by another firm. The task is stark reminder of what can go wrong in construction projects, warns Sabooni.

"The quality of architecture and design can be very high here and you have to get the right developer to go with that - if you want the best building, you cannot build it to low standards." Of course, the solution to the problem should be pretty straightforward: money: "In order to get the best you have to pay the highest - that's just the way it is."

In many ways, the growth of healthcare in the Middle East has been tied to the region's efforts in embracing free market principles. Unfortunately for those looking to set up in the region, the forces of supply and demand don't always favour healthcare.

The Middle East's hospitality boom has meant that contractors already have their hands full with lucrative, and often straightforward, hotel projects.

"It is very difficult to get contractors nowadays. People don't easily commit to healthcare projects because it is a little bit tougher than the ordinary construction," complains Mohanakrishnan.

"They get the same amount, or more, from doing hotels and apartments - so their attitude is, ‘why should we do more complicated work?'" Nevertheless, contractors are still available for healthcare. The trick is to pick the ones with experience (and to pay for it), rather than the ones that other industries wouldn't touch - otherwise, like Zabooni's client, you might end up paying twice.

Hire at will

Doing two things at once is never easy, but if you have only started thinking about finding staff as your facility nears completion, then you are already far too late.

Healthcare professionals, especially physicians, need a lot of lead-time before making a career switch. And when you consider that moving to the GCC entails no small amount of paperwork, you really can't start too soon.

"You need to start thinking about recruitment at least 12 months beforehand," insists Mick Whitley, commercial director of UK-based HCL International. HCL is currently working with a string of the largest hospitals and healthcare groups in the region, such as Health Authority Abu Dhabi and Emaar Healthcare, and Whitley's top tip for recruiting to the Middle East is to give as much detail about the role on offer as possible.

"I think the key thing is clarity - doctors need to know exactly what it is they are going to be doing, how much they are going to be paid, and what the benefits of the package are."

One of the trickier aspects of recruiting to the Middle East is that even though you have to approach individuals with concrete offers far in advance, the job market is a lot more turbulent than most of the physicians' home countries.

"Things change very quickly in this region as far as salary packages and contracts," he states, "and if you are from North America you will not be used to that."

Each Gulf country has a different approach to licensing expatriate physicians, but, to a Ministry, they all have a reputation for being teeth-grindingly thorough. Once a physician has accepted your offer you have to prepare yourself for some lengthy fax correspondence. "The professional licensing process can easily take more than two months," says Dr Mohanahrishnan.

"At DHCC, you have to introduce all the copies of the doctor's certificates and details about their experience to the CPQ - the CPQ will send copies to the university that has offered them and then wait for confirmation whether the details are genuine or not. Once the reply comes there is a CPQ committee meeting and the application will be considered and they will decide whether the person can be licensed or not."

It is also important to remember that although the Middle East's healthcare sector is developing apace, most of the top doctors will already be far ahead of the game when it comes to professional development. As a recruiter, it is vital that you can convince top clinical staff that moving to the GCC is not going to stall their careers.

"A big draw for staff is if you can give them access to hi-tech equipment, research and continuing education - they are very, very important for medical professional," recommends Whitley.

"So if you can't offer ongoing education at your facility, you should be prepared to fly physicians to those events - not all hospitals offer that, but they should."

Eyes on the prize

Like practising medicine itself, starting a healthcare facility in the Middle East is an imprecise science. Due diligence when creating a business plan will pay dividends, but only if you are able to stay cool in the face of the region's often maddening business conditions.

Taking care of the design and construction of your facility, and recruiting the right people, will be fundamental to the success of your business - so even though it can be onerous at the time, compromising as little as possible on what you want your practice to look like, and who you want to run it, is essential.

THE FACTS: MT's practice planning essentials

Red tape rage:Like it or lump it, bureaucracy stands in the way of you and your business - don't fight, get through it.

Water hassle:Medical buildings need more than just doctors to make them run.  Sort out basic power and water supplies as soon as possible.

A design for life:Just because building a facility in the GCC can be difficult doesn't mean it should be simple - pick a design that you are proud of.

Recruit to success:If you build it, they won't come - not unless they've seen a contract, that is. Start well in advance to avoid downtime.

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