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Mon 20 Oct 2008 04:00 AM

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Follow the leader

Dr Alan Sandford, CEO of Sharjah's Al Qassimi Hospital, on why it could become the hospital to watch.

Two years ago, Sharjah's Al Qassimi Hospital (AQH) was understaffed, underfunded and under-efficient. Now the facility once dubbed a white elephant is on track for a comeback. Dr Alan Sandford, CEO and chief medical officer, tells Medical Times why Al Qassimi could become the hospital to watch.

In your role with consulting firm VHA Global, you took over the running of AQH last year. Tell us about the tie-up.

VHA Global was asked by the United Arab Emirates' Ministry of Health to undertake a hospital improvement project - so to put in place governance and management arrangements for Al Qassimi hospital to meet international standards and to move towards accreditation.

We have plans for a big expansion to our emergency department… [and] for the construction of a women’s and children’s hospital within this precinct.

The ministry wants to make its hospitals more autonomous so they run more efficiently, and are accountable. AQH has been given a rather unique challenge in becoming semi-independent. The ministry funds us, so we're not independent until the ministry decides to give us control of our budget.

Then we become like a private hospital. The first step of that has been the creation of a board of directors, which is the governing body for AHQ. This is the only public hospital in the UAE with a governing body separate from the ministry that reports back. We're the largest ministry hospital so everyone is watching us.

Until recently, AQH was dogged by pay complaints, resignations and underfunding. How hard has it been to change that?

The answer to that is of course, very difficult. Because organisational development, which by necessity involves change, is always difficult. People will say, ‘nothing changes' and complain [but] my experience is that people claim they want change, but with the hidden, unspoken proviso; ‘as long as it doesn't' affect me'.

Change management is one of the more challenging aspects, particularly if you have something that has been in place for many years, which it has in the case of AQH.

 [We] look very much to a partnership model of development, rather than coming in and telling people how it should be done. Putting in place policies and procedures that are transplanted from somewhere else is not the way to do it.

How have you improved the staffing situation?

It's been frustrating, and not just for the staff that were preexisting. Pay has gone up, but that wasn't in the control or remit of VHA at all. There was a 70% increase in the salaries that went across the ministry. It was a major pay jump, calculated on base salaries. It has been gratefully received by staff, as there is more parity with Dubai hospitals now.

Some of the more challenging [issues] now are human resource management, equipment procurement and  financial management - none of which was previously within the remit or the authority of the hospital.

AQH's board of directors is now responsible, but before [the budget] was all centralised through the ministry. The idea is now that we'll create models that can be used by the other ministry hospitals to improve efficiency.

What impact has that had on staff retention rates?

I haven't got the exact figures, but I would say its likely [resignations] have gone down.But it's not just pay - it's about opportunity. And that's one of the biggest challenges I have, to make this hospital a preferred employer.

We're just about to do an employee satisfaction survey, not just to identify whether people are grumpy or not, but to get their ideas. Because increasingly, and with a bit of bemusement from some of my department heads; I say; ‘Come to me not just with the problems but with suggestions and ideas.' You get a more engaged group of professionals and they're less likely to become disgruntled and resign.

Has AQH up to its full staff capacity yet?

I'm not aware of any data that suggests healthcare is disadvantaged in the northern emirates as compared to elsewhere. Not even anecdotally.

We're in a recruitment phase. [The ministry] has signed off what I would call a very ambitious staff increase of some 500 staff - doctors, nurses, technicians and administrative staff. It's a significant upgrade of our capacity. And it's certainly interesting that we've noticed applicants from both the government and private sector from other emirates are now looking at us as another option.

As the largest hospital in the northern emirates, AQH has the highest patient footfall. How are you meeting demand?

AQH is a major workhorse. We cope with the number of patients, but it's difficult. We're the major referral hospital in the northern emirates and it's an expanding region, so we're stretched.

We have plans for a big expansion to our emergency department to handle the more than 90,000 patients a year than come to the department, [and] for the construction of a women's and children's hospital within this precinct, so to be part of AQ hospital. So we're expanding to meet the needs.

There have been ongoing rumours about Sharjah developing an independent health authority. Do you think that is likely?

I wouldn't want us to go down the path of thinking ‘because Abu Dhabi and Dubai have health authorities, Sharjah should have one too'. I don't have any problems with the creation of yet another health authority, provided it's clear what the advantages are. I've yet to see any real outline of the Emirates Health Authority, which is expected to cover the northern emirates anyway.

The jury's out for me.

The northern emirates don't seem to have followed Dubai and Abu Dhabi's lead in terms of mandatory health insurance and the privatisation of government  hospitals. Why?

I think the drivers are different. The ministry as a federal agency, which is largely funded by Abu Dhabi, has a big responsibility to cover all the national agencies. And I think they are still grappling with the best way to do that, and also to look after the national population. Any health insurance arrangements and health reforms need to be taken into that complex mix.

But coming last on policy changes is not always the least desirable, because one has the opportunity to see what has and hasn't worked elsewhere. We'll have a tried and tested model.

The proof of the pudding is in the outcome, and I'm not aware of any data that suggests healthcare is disadvantaged in the northern emirates as compared to elsewhere. Not even anecdotally.

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