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Carl Stanifer

UAE, ABU DHABI - Health & Education

The Human Factor

Group CEO, Abu Dhabi Health Services Company (SEHA)


Carl Stanifer has a degree in Accounting and Finance from the University of the Cumberlands and conducted graduate studies in Health Planning and Administration at the University of Cincinnati. Prior to joining the Abu Dhabi Health Services Company (SEHA) in August 2007, he was CFO of Bumrungrad Hospital in Bangkok from January 2004. He has worked in the healthcare sector for over 42 years.

"We have systems in place to monitor results, so we know if the actions we are taking are related to improving outcomes."

What is the overall goal and strategy of Abu Dhabi Health Services Company (SEHA)?

It goes back to 2006 when the government of Abu Dhabi hired McKinsey & Company to look at the health sector and how healthcare was provided, how financing was done, and the level of health coverage for the population. It was a massive study and one key recommendation was that the provision of healthcare, the funding of healthcare, and the regulation of healthcare should be separated into three autonomous organizations. The Health Authority of Abu Dhabi (HAAD) was formed to do the regulation, Daman was formed as the national health insurance company, and SEHA was formed as the provider of public health services. Our job was to own and operate all of the government’s healthcare assets. We brought them all together under one organization and became operational in January 2008. We owned the assets, land, buildings, equipment, the vendor contracts, and all the employment agreements with employees.

What are we talking about here in terms of the change?

The objective was to instill the discipline of a private company, in terms of accountability, to stakeholders and the production of financial statements and budgets, through a legally private, albeit 100% government-owned, company. The most important objective was to then focus on improving the quality of care and the level of service to patients. It was perceived at the time that the quality of care and the level of patient services were below expectations. At that time, there was really no empirical data; it was all anecdotal because there were no systems in place to accumulate data, so we spent a good deal of our early years just trying to understand baselines. It took a long time to get all that in place because we started from very disparate, disorganized, and unsystematic systems that were in place at that time. If you contrast that to today, it is a world of difference.

“We have systems in place to monitor results, so we know if the actions we are taking are related to improving outcomes.”

Do you feel that there is an increasing trust in health services?

I do feel that there is a rising level of confidence, but one of our biggest challenges is still to earn back the credibility that was lost in the early years prior to SEHA. You do not earn that back quickly, so that is something we are constantly trying to improve on. The issue of people going abroad is not an area of responsibility for SEHA; this falls under the purview of the HAAD, but if you break the data down, there are many reasons why people go abroad. One reason is we do not have certain services here because it would require very rare and specialized physicians. It is easy to build the building and buy the equipment, but getting the physician and the ancillary support staff to come here is sometimes an extreme challenge. Secondly, we might have the service, but we do not have confidence from our client base. We have an immense ability to improve our situation here and reduce the number of people that do go abroad for treatment. That is one of our main objectives to help the government in that regard.

How do you bring international standards to the workforce and knowledge transfer to locals?

We do a lot of different things. First of all, on the clinical side, it starts with the education system. We do not run medical or nursing schools, but you have to have special qualifications to come and work for us. Not enough Emiratis are pursuing medical careers, so we have started visiting high schools, for instance. We also work with the Tawteen Council and other Emirati organizations to convince students at the high school level to enter the health profession on the clinical side. The second thing we do is to provide post-academic training in our hospitals. Once nurses graduate, we bring them into structured, formal graduate nurse training to help them develop sub-specializations and finish off their education in a practical setting. We do the same thing for physicians by running residency programs. We recently received ACGMEI Accreditation for these residency programs, so now when our physicians finish the program, they have a better documented process of education to become specialist doctors. That then allows them, in their last year, to practice medicine of a higher caliber. Right now, less than 2% of our nurses are Emiratis, but almost 22% of our doctors are Emiratis because of these training programs. We have looked long term at where we will be in 2030 with our percentage of Emiratization in the area of doctors, nurses, and allied health professionals, but I do not think that we can ever achieve much greater than about 20%. There are only so many Emiratis, and only so many that are going to go into clinical work. Our longer-term goal is to reach somewhere in the 20% range on the clinical side of our business. On the administrative side, we have very structured programs for the senior leadership. We really focus on these individuals at the leadership level. We work with them on a mentoring basis, where we do a lot of on-the-job and structured training to increase their leadership skills. As a result, we have gone from about 33% Emiratis in the administrative group, to over 50%. We think that we can get to 75% Emirati administrative staff by 2030.

Are there opportunities for more international partnerships?

We are changing our model for partnering with international organizations. Initially, we started partnering at the hospital level. For example, when we took over Mafraq Hospital, we partnered it with a Thai company. We partnered Al Ain Hospital with an Austrian company, Sheikh Khalifa Medical City was partnered with the Cleveland Clinic, and we partnered Tawam Hospital, Corniche Hospital, and Al Rahba Hospital with Johns Hopkins. When SEHA was first formed, we did not really have a lot of management and system tools, so one of the reasons for these partnerships was to rapidly advance our ability to implement computer systems and accounting regimes. Now that is done, we are changing our model. Instead of partnering at the hospital level, we are asking these organizations to partner with us to treat a patient population of medical services. They will not be management contracts anymore; they are migrating to clinical affiliation agreements. We will work with Johns Hopkins, for example, to clinically support our women’s health services across all of our hospitals and clinics. They will not manage our hospitals, but will help us clinically support managing a population of medical services. We have identified 15 of these clinical service lines and, of those, we will partner five or six with international organizations. We have a tender out now on pediatrics, and we have identified seven or eight top organizations in the world and have offered them the chance to respond to the tender. Over the next three or four years, we will be working with our existing partners to migrate from these hospital-specific to clinical, population-specific contracts. We are in discussions with Cleveland Clinic and Johns Hopkins to do that and we will bring in new partners.

In the short term, what will we see in Abu Dhabi in terms of the standard of healthcare and the kind of facilities that are available?

Addressing the facilities, first of all, as many of our hospitals are 30 or 40 years old. We are replacing them. We will be opening a new Mafraq Hospital in 2015, and we are going to replace the Al Ain Hospital. We are building and expanding hospitals in the Western Region. We will build a new Sheikh Khalifa Medical City over the next six years. A new Corniche Hospital will be developed and placed on the campus of the new Sheikh Khalifa Medical City. We have already done a lot in the outpatient setting, and we have done much for dialysis care. We have opened a new facility, the Mafraq Dialysis Center, and we are going to open one at Tawam and one at Sheikh Khalifa Medical City. The facilities side is well planned and the road map is there for the next six years. That is the easy part, though; the tougher part is getting the right staff to really make a difference. For that, we have to boost the skills of our current workforce. When we replace people, we will bring in people with more skills, and also train internally. We need to get more physician consultants, upgrade the skills of our GPs, and obtain more nurses who are specially trained in areas such as neo-natal, pediatric, and surgical intensive care. We have a lot of work to do. We are understaffed today. The quality of the care is directly related to the number of nurse and physician hours per patient, and we are continually improving that. At the same time, in order to know if we are making a difference, we have to monitor clinical outcomes. We have systems in place to monitor results, so we know if the actions we are taking are related to improving outcomes. We can then see quality correlations as we deploy more tools.

© The Business Year – October 2013



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