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Paul Johnson is the business development director for Outsourcing Consultants, a Dubai-based consultancy with a specific focus on the medical industry. The company offers the full spectrum of HR services, from software to complete recruitment management.

For more information, call +971 4 359 7282, or visit www.outconsult.com.

Dr Sahar Al-Dossary is the senior deputy executive director of paediatrics at Saad Specialist Hospital, Saudi Arabia. She completed her residency at the University of Southern California and Kaiser Hospital of Southern California,and is a fellow of the American Academy of Pediatrics.

Visit www.saadmedical.com for more information.

Nart Mamser is the head of Siemens Medical Solutions for the lower Gulf region. Siemens is known for bringing together medical technologies, information systems, consulting and support services to help customers achieve sustainable clinical and financial outcomes.

For more information, visit www.siemens.com/medical or call +971 4 282 1819.

Q: If a parent refuses to have their child vaccinated (and the vaccination in question is not mandatory for school attendance) is it necessary to document the refusal in the child’s medical records as a disclaimer?

S.A. answers…

There are the usual routine immunisations that are recommended by many countries and are required for school entry or the Ministry of Health. There are also many other immunisations that are not on that list but are the responsibility of the paediatrician to recommend. I believe that every paediatrician should educate the parents of his/her patients on the effect and benefit of vaccines. If this education is given properly, most parents will agree to vaccinate their children. If, on the other hand they refuse, I believe that the paediatrician should understand the reason for refusal and try to educate from a different aspect. If then he/she fails, it is mandatory to document parental refusal in the patient’s chart. The physician needs to record that full and proper information was given and that the parents refused. Many hospitals in the west require the parent to sign a form that states that information was given and the risks of not giving the vaccine were explained in full detail, yet the parent refused. In certain cases in the US, some paediatricians have gone a step further and taken parents to court, claiming that their refusal to vaccinate amounts to child neglect or abuse, through failure to protect the child from certain diseases. This is a very controversial issue in some American states, as the use of certain vaccinations contravenes the religious restrictions of certain religious groups. An example of this is the HPV quadrivalent vaccine, which is designed to prevent HPV types 16 and 18 (the cause of approximately 70% of cervical cancers) as well as HPV types 6 and 11. For some far-right groups, the introduction of this vaccine has been both a political and health issue.

In the end, it remains best practice for the paediatrician to do his or her best to promote proper education to ensure a healthy community, which will lead to a more productive population. If we fail to do that, it means that we as physicians are not educating properly or effectively.

Q: Is it advisable to create an employee policy manual for our practice, or is there a risk associated with putting things in writing? We’ve been told a written manual could put us at risk for an ex-employee suing us, but I think it would be beneficial to have written policies for all our staff members.

P.J. answers…

Thank you for your enquiry. It is a pleasure to hear that you as a healthcare provider are considering a transparent HR policy. This region is slowly waking up to the fact that the old “hire em and fire em” mentality, where it was believed that if we lose someone there will always be someone to replace them, is long gone. The era of globalisation and rapid economic growth of the region has put paid to any notions that good staff, particularly in healthcare, are easy to find. There is a worldwide shortage in our field, which is only set to get worse as this region expands further. There are a staggering number of projects either in the planning or building phases, which will create a huge need for staff. Employee retention is becoming vital. A clear, defined and transparent set of HR policies is a good step forward to making staff feel valued, provided these policies are fair to both employer and employee and lay within labour laws.

Written policies will help encourage consistency with your employees, and ensure all staff members understand what is expected of them. Having a written dismissal policy – for example, laying out the steps an employee can expect to go through, including first warning, written warning etc., – is a very effective way to protect your practice from claims of unfair dismissal.

Both parties should of course, accurately follow HR policies. Should this be the case then you are less likely to risk being legally challenged by an employee. However, should you as an employer be in breach of your own policies then you are open to an ex-employee challenging you. This would be the case whether your policies were committed to a manual or not, as the bare minimum expected of an employer is that outlined in the labour law. Should you fail to follow these guidelines, you could be open to problems on the legal front.

As a summary, I applaud your line of thinking in laying out a formal manual of staff HR policies. I believe this is vital for any forward thinking employer who would like to confirm to worldwide best practice in the HR field. This initiative will contribute to your staff retention goals and is in no way negative, provided of course the policies are adhered to.

Q: We are in the process of building a new clinic that will use electronic medical records. We are interested in designing our exam rooms to maximise workflow. Have you seen any design changes that practices have made while implementing EMR that you would recommend?

N.M answers…

When designing modern exam rooms in order to accommodate healthcare IT, a few simple things have to be considered, though we don’t see many changes in the general design. First you have to make sure that there is space for monitors, computers and keyboards (whether the physician is using a tablet, desktop, or laptop) as well as space to spread out any remaining paper items. Although monitor footprints are becoming smaller with flat panels, you will still need some, ideally sit-down, space.

Adequate lighting to be able to read the monitor is important, though typically well considered by commercial architects. Obviously one needs to ensure that there are sufficient power outlets and network access points for current and future IT needs.

You should also consider whether you are going to want to be able to show the patient the screen, for example to share x-ray or blood test results, particularly those that require patient compliance such as glucose or cholesterol. Try to avoid forcing physicians to use the screen with his or her back turned to the patient, but consider positioning the screen so the physician can sit alongside the patient while using the EMR.

Another consideration is whether the practice will be using high-resolution imaging data – for example, an orthopedist or neurosurgeon may want to have more space in their exam room to be able to support a second high-resolution monitor solely to look at images.

As an aside, hospital staff have found it is better to have PCs in a workstation area in the hallway, rather than actually in the patient room. It can become distracting for patients and their families when clinicians appear to be spending rounds time looking at the computer instead of interacting with them – and it can also be distracting to the clinicians who are trying to manage the patient.

The answers provided in this feature are for information purposes only, and intended to provide general guidance. They should not be relied upon by readers, who should seek further professional advice.

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