Managing Change: Case Study of Wareed System for Ministry of Health in United Arab

Introduction of Wareed System

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The Wareed System was initiated by Ministry of Health across United Arab Emirates in 2008. The organization believed Wareed System would establish operational and administrative changes in managing health among United Arab Emirates residents. Thus, the one patient one record was deployed after Cerner Millennium links data into a unified system enabling information to be securely stored and accessed through a portal while using either a smart phone or browser. The United Arab Emirates Ministry of Health was therefore the initial party to roll out the component portal across the Middle East State. Wareed system can be described as an online portal that is bilingual as it utilizes both English and Arabic languages in order to integrate patients’ health records. This further allows United Arab Emirates residents to communicate openly with nurses and care givers providing services through the Ministry of Health. sDr. Mohammed Al Olama is the Undersecretary for Health. He believes the Wareed System has been fulfilling the vision developed by the vice president, prime minister, and Ruler of Dubai known as Sheikh Mohammed Bin Rashid Al Makoum. He has been on frontline to initiate projects aimed at transforming the government in line with technological growth and developments effectively and efficiently. Residents in Dubai and Northern Emirates are therefore able to access their health records securely (PAC 2010, p. 18).

Functions and operations under Wareed System are undertaken as follows. Foremost, the Member Portal indicates how patients from Northern Emirates and Dubai ought to engage with Ministry of Health. This function aims at improving transparency and choice of health provision on personal basis enabling healthcare providers and receivers to be more involved with personal health management. The Care at Home function presents how home connected self devices can be effectively and efficiently utilized by a patient to access health care for twenty four hours. For instance, some patients rely on video consultation and secure messaging with nurses and care providers from Ministry of Health to access and receive medical services from home. The Population Health function demonstrates how Ministry of Health ought to manage healthiness in order to provide medical services across United Arab Emirates. This function ensures Unified Health Record Initiative is able to provide crucial information required by physicians, administration and researchers across United Arab Emirates. Wareed System is therefore keenly utilized to support efforts by Ministry of Health aimed at transforming the health care sector in United Arab Emirates. Implementation of population management has been underway since January 2015 to achieve the ultimate goal of bringing proactive and continuum health care services to patients’ doorsteps (MoH 2013, p. 2).

Research Methodology

Wareed System has integrated interactive portal functions aimed at delivering advanced web-based health care services. It ensures clinicians manage issues presented by patients on various hospitals and clinics across United Arab Emirates while providing back-end support to bilingual individuals accessing information and healthcare services from help-desks managed under the United Arab Emirates Ministry of Health. The channels utilized are secure and interactive as they advocate for transparency with regards to lab tests, prescription histories, appointments, and portability of members’ healthcare records. In order to compile this essay report, findings from desk research reports published though academic journals were utilized. This is because they also integrated information gathered from interviews conducted by researchers. The interviews were conducted on experts across business and government departments utilizing the Wareed System. For example, a research commissioned by Waha Capital provided crucial information as it compiled interview responses provided by various participants. The participants include chief executive officer at the Al Zahra Hospital in Dubai known as Dr. Mohaymen Abdelghany. A consultant working with Health Funding Department in Dubai Health Authority known as Robin Ali was also interviewed. The rest included Jerome Droesch the chief executive officer at AXA Gulf, Sami Alom the chief strategy officer at Al Noor Hospital Group, and Ben Frank the chief executive officer of Cleveland Clinic Foundation at Sheikh Khalifa Medical City in Abu Dhabi among others (MoH 2013, p. 2).

The interviews were performed by The Economist Intelligence Unit to gather desk-based research information with regards to Wareed System. The interviews commissioned by Waha Capital sought to determine government’s national strategies across United Arab Emirates being implemented in order to raise quality of healthcare services to international standards by the year 2021 (TEIU 2015, p. 5).

The interview questions were as follows.

1. What are the main quality gaps experienced across United Arab Emirates healthcare sectors?
2. What are the changes to be achieved by implementation of the Wareed System?
3. Does Wareed System aim at integrating public and private healthcare sectors?
4. What are the implications of changes experienced after implementation of the Wareed System?
5. How can the 2021 healthcare goals be achieved and gradually enhanced across United Arab Emirates?

The interviews were conducted when the United Arab Emirates government sought to improve national strategies aimed at raising quality of healthcare to international standards.  The interviews therefore took place in 2015 to determine how human and financial capitals are being utilized to achieve international healthcare standards. For example, various staffs across clinics and hospitals were interviewed to describe their capacities and skills. Consequently, the interview results were utilized to determine how financial, human, and physical resources ought to be managed to harmonize the Wareed System (MoH 2013, p. 2).

Interview Findings

Based on the interview questions listed above, the following findings were retrieved. Foremost, chief executive officers from various healthcare facilities revealed hospitals and clinics are not at full capacity as the physical infrastructures are not able to keep up with the demand. This challenge is further fueled by lack of human capital as expatriate workers are mainly transient as they dominate the healthcare sectors leading to levels of agitations. As a result, they should be offered financial and non-financial incentives to encourage them in lengthening the amount of time they ought to spend and provide skills across healthcare facilities. Conversely, human resources essential to provide mobile health services can either be assisted or supplemented through use of technologies. Ultimately, this will ensure demands across the healthcare sector are met and fulfilled (Ghaleb 2012, p. 2).

The interviews revealed private sector has been undertaking a bigger responsibility than the public entity in ensuring healthcare services are accessed and provided across United Arab Emirates. The private entity for instance has provided a larger number of nurses, doctors, and beds than the public sector. The key role in managerial outsourcing to attract international healthcare providers however has been fulfilled by the public entity as they are bound to introduce international healthcare performance standards. Consequently, this will lead to improvement of healthcare services while encouraging investors to rely on the existing unique dynamics to implement changes through the Wareed System. Dubai, Abu Dhabi, and Sharjah have played a key role in taking responsibilities allied to healthcare policies. Differing protocols and standards however have been impeding the quality of services being offered and accessed across United Arab Emirates. As a result, transaction costs such as operational and licensing expenses have been increasing. Consequently, relocation of staffs has been challenging as it can be difficult to strike a balance between local autonomy and the harmonized Wareed system (Ghaleb 2012, p. 3).

Majority of parties interviewed are working within the diverse healthcare facilities in United Arab Emirates. They asserted that data providing historical information on the quality of services has been scarce. As a result, there has been limited information required to guide patients with regards to facilities they ought to visit in order to seek treatment. Information to help payers and regulators from various insurance companies tasked in overseeing quality of services has also been scarce. As a result, people have had the perception that healthcare providers offer low quality services due to insufficient data and facts. This however has encouraged the United Arab Emirates Ministry of Health to enhance accreditation of global standards. Consequently, data collection to enhance patient protection and safety measures has been increasing within in Dubai and Abu Dhabi. The ministry of health asserted that, critical data will be collected and published between 2015 and 2016 in order for patients to make informed decisions regarding local treatments. Consequently, payers and the government ought to utilize gathered data as an influencing factor in determining pricing, licensing, and remuneration policies (MoH 2013, p. 2).

In conclusion, the interviewers provided insights on how to achieve the 2021 international healthcare standards. They asserted that, they had observed many patients seeking medical services from abroad such as Germany and Switzerland especially in treatment of diseases such as cancer. Thus, two in every five residents across United Arab Emirates prefer to seek medical services from abroad as local services have historically been regarded as lower in quality than other developed nations. High rates of healthcare tourism should therefore be addressed and reduced by enhancing quality of medical services offered locally. Consequently, patients’ trust levels to seek local medical services will improve encouraging internal healthcare providers to improve medical practices and standards. For example, the former chief executive officer of the Health Policy and Strategy Sector in Dubai Health Authority known as Laila Al Jassmi asserted that, governments ought to enhance medical services being accessed by patients on local levels. To achieve this goal, the government should expose medical providers to uncommon healthcare conditions such as surgeries in order to enhance their skills and experiences. Consequently, the patients will gain trust as the providers will be skilled to offer high quality services. This will enhance the reputation of medical services being offered encouraging people to seek healthcare services across United Arab Emirates in order to reduce outward medical tourism. Mandatory insurance will ensure access to healthcare services increases. Consequently, the number of doctors, beds, and care givers will be increased. Coupled with sophisticated regulations to deal with emerging healthcare needs, United Arab Emirates Ministry of Health is bound to achieve international practices and standards by 2021 (TEIU 2015, p. 17).

Reason that led Ministry of Health in United Arab Emirates to implement changes

The interview findings provide insights on the various challenges faced by Ministry of Health across United Arab Emirates. Developing the Wareed System was therefore a strategy to address and resolve the challenges. Reasons that led Ministry of Health to implement changes through the Wareed System are as follows. Foremost, doctors across United Arab Emirates had been dealing with a cumbersome process involving multiple alterations of reports, secretarial transcription and attendant corrections. Through the fully integrated digital Wareed System, the Ministry of Health has been spearheading healthcare improvements aimed at transforming and revolutionizing the delivery of safe, high quality, efficient, and effective public medical services. Thus, the changes were implemented to ensure such nuances experienced by doctors while working with local partners are resolved and eliminated. For example, several hospitals across United Arab Emirates considered among the busiest have implemented changes allied to the digital Wareed Healthcare System have introduced Dragon Medical protocol to assist medical teams such as radiologists, pathologists, and surgeons to be fully and effectively equipped. As a result, they have been meeting and exceeding consumers’ needs and expectations (TEIU 2015, p. 7).

Mohamed Nabeel AlDoy has been the Wareed Project Manager of United Arab Emirates Ministry of Health. He maintains medical providers across the region are busy. As a result, it has been challenging to schedule diverse technological training sessions. After the Wareed System was implemented however, the training sessions have been short encouraging medical practitioners to attend and receive training. The main reason for implementing changes through the digital Wareed Healthcare System has therefore been allied on the need to increase accuracy rates reported by medical providers. Consequently, their levels of productivity have been increasing further enabling medical providers to reduce wastage of time and resources on administration of patients’ reports. Dr. Hatem Abu Abbass the head of Medical Diagnostic Imaging at Al Qassimi Hospital in Sharjah can affirm that implementing changes due to the reason discussed above has been vital. He asserts that, doctors who are often busy addressing emergency medical issues do not like dealing with a system with a scheduled outrage lasting up to three days. This is because the medical providers are demanded and pressured to do so much in advance to avoid being adversely affected by the outrage. Since the Wareed System was implemented however, doctors have observed various pleasant changes. For example, they are able to write comprehensive reports without omitting some information crucial in description of the patients’ medical history, needs, and requirements. More so, the reports can prepared quickly and stored safely for future referencing (NCI 2013, p. 2).

Dr. Somaya Abdullatif Al Zaraooni is the Head of Pediatrics in a hospital utilizing the Wareed System. He affirms that, before the Wareed System was implemented at the Al Qassimi Hospital, secretaries faced diverse challenges in transcribing doctors’ notes. As a result, a lot of time was wasted in correcting mistakes as either the secretaries or doctors would often misspell various medical words. The new medical protocols under Wareed System have therefore ensured doctors are able to dictate notes and the reports published immediately. Thus, the changes implemented through the Wareed System have reduced medical errors, spelling mistakes, and amount of time taken to write and store a patient’s report to the database (NCI 2013, p. 2).

Wareed System has also incorporated speech recognition practice. The General Surgical Consultant at Umm al Quwain Hospital, Dr. Adel Zaki Al Taweel asserts that, writing patients’ reports in longhand was exhausting and time consuming before the digital system was implemented. This is due to the fact that, they also spend extra time correcting spelling errors. This however has changed as they no longer use pens in either taking notes during rounds in the hospital or writing patients’ full reports. Currently, they just rely on voice recognition to ensure the report production process is easy, fluent, less time consuming and more accurate. This is because the screen shows the doctors their reports as soon as they finish using the speech recognition software (NCI 2013, p. 3).

The Wareed System was also implemented to enhance security measures. This is because the system ensures persons without authority to access data are denied entry. For instance, Dr. Hatem Abu Abbass is the Head of Medical Diagnostic Imaging at Al Qasdimi Hospital. He affirms he has attempted to gain entry into the system without permission unsuccessfully severally. As a result, the system can be utilized in storing personal reports while ensuring patients’ medical information reports are safe. Ultimately, the Wareed System was implemented to ensure state of the art protocols, applications, or software is utilized in providing patients with the best high technological healthcare services. More so, it has allowed doctors, nurses and support staffs from various hospitals in United Arab Emirates have received training. This has enhanced their skills while motivating them to be more committed in order to increase productivity levels (NCI 2013, p. 3).

Description of the processes during change implementation

Before the Wareed System was implemented, nursing supervisors had to visit all the units in a hospital while recording information on a paper.  This was referred to as collection of the twenty four hour Nursing Report which was utilized in collection of statistics regarding each unit’s daily activities in a particular hospital. The progression was time consuming and burdensome. Manual tasking in collection of data of reports allied to operations, admissions, transfers, and discharges denied nurses and supervisors the opportunity to focus on patient care. When receiving new staff members and scheduling shift changes, nursing supervisors had to repeat the procedure every morning, evening and night. The final report had to be provided to the Medical Director and District Director for effective, efficient, and timely decisions to be formulated and implemented. Thus, if the reports were inaccurate the decisions would be ineffective. As a result, reporting procedures were considered time, energy, and resource consuming without guaranteed favorable results (UAE-MoH 2013, p. 29).

Currently, manual reports have been substituted through use of electronic forms. The current Wareed System twenty four hour Nursing Report protocol was designed and built to ensure that, with single click information is either extracted or posted per shift at each particular time. For example, Sheikh Khalifa General Hospital holds over two hundred beds. Using the Wareed System, nursing supervisors are able to acquire patient statistics including their admission, transfer, and discharge or decease reports. Secondly, a section comprising of patients reporting to administration is maintained. The section pulls patients’ data to determine those that are critically ill, unconscious, ventilated, or have experienced critical incidents that ought to be reported. The data pulled is acquired by nurses’ notes as they provide care to the patients.  The other section involves acquisition of data regarding patients that have passed away. If a nurse witnesses a death, she/he should note the incidence during that particular incidence. These sections have therefore improved patient care and nursing supervision as well as accuracy, consistency, and timely measures during data collection (Ghada 2015, p. 1).

Comparison of the changes with literature

According to the United Arab Emirates Business Council, the healthcare sector has been expanding due to growing needs and economic diversification. As a result, Emirates States strive to ensure healthcare services are accessible and affordable while developing local workforce simultaneously. There are five healthcare regulators namely; Ministry of Health, Finance, Federal Health Insurance Authority, Dubai Health Authority, and the Health Authority Abu Dhabi. They are tasked in ensuring regulating healthcare service providers while addressing critical concerns as presented by patients. For example, they seek partnerships able to enhance the healthcare sector in order to address and integrate Information Technology infrastructures while treating and preventing communicable and non-communicable diseases (Ghada 2015, p. 1).

After implementation of Wareed System, firms with a workforce exceeding one thousand individuals are now required to provide staffs, dependants and domestic workers with medical insurance. All hospitals are also required to be accredited by the Joint Commission International in order to develop international licensing and medical standards as well as practices. Improved data collection procedures have had to be complimented by ensuring United Arab Emirates governments monitor the healthcare sector. This will ensure medical service providers are empowered to make informed decisions while seeking treatments. These changes have ensured United Arab Emirates is able provide quarterly basis medical reports affirming healthcare services, practices, and standards are improving (Ghada 2015, p. 2).

Resistance experienced

The main resistance experienced was due to lack of straightforward evaluation and performance assessment benchmarks across United Arab Emirates. This is due to the unique United Arab Emirates demographic structures enabling locals to form a small fraction representing the overall population. As a result, a high number of citizens in active employment and those that are expatriates fail to seek medical services locally. Thus, they do not rely on the normal healthcare systems profoundly. In order to address the resistance, the licensing of Board Certified Physicians has had to ensure issues allied to human capital are resolved. This has involved streamlining United Arab Emirates human capital resources to enhance transparency. As a result, more medical providers have had to be recruited, trained, and retained to avoid understaffing. Consequently, persons from diverse social, economic, and political classes have gained courage to seek medical services locally as they can now trust the practitioners (UAEBO 2014, p. 11).

Critical success factors of change management

There are several critical success factors ensuring managerial changes across the United Arab Emirates Ministry of Health through use of Wareed System are achieved. Foremost, it was discovered that more than fifteen percent of healthcare providers do not offer their services in United Arab Emirates preferring to work abroad. This has been burdening the locally available facilities as they strive to attract replacements in the industry from Europe and United States (UAEBO 2014, p. 9).

As a result, adequate healthcare education and training should be provided across United Arab Emirates. This will ensure medical providers from United Arab Emirates are able to gain knowledge, skills, and experience required to offer services as a doctor, nurse, physician, and technician among other healthcare providers. More importantly, healthcare infrastructures in United Arab Emirates are insufficient. Improving the infrastructures will ensure medical providers who are skilled, qualified, and experienced do not seek better opportunities abroad. Consequently, they will be attracted and retained across United Arab Emirates. This will encourage them to seek further medical education, acquire state of the art facilities and establish a regional practice network enabling healthcare providers to exchange ideas and attain international practices and standards (Musaab 2014, p. 51).

Summary

Wareed System is supportive and valuable healthcare software or application ensuring issues affecting United Arab Emirates healthcare sector are addressed and resolved. This is because it has been improving quality of healthcare services at reducing costs while improving efficiencies. Although United Arab Emirates has been experiencing a shortage of skills and staffs, Wareed System has been ensuring externalization and outsourcing of medical providers resolves the issues arising. More so, the resources and infrastructures required to sustain the system are locally available. The system however should focus on ensuring private and public sectors collaborate in addressing healthcare issues in the region. This is vital in improving payers, regulators, and providers’ efforts as private and public entities across the seven Emirates states streamline federal and local operations. Ultimately, Wareed System should ensure private and public entities acknowledge information technology is the solution in overcoming operational, administrative, and managerial challenges being experienced across United Arab Emirates by the ministry of health.

References

Ghada, S 2015, United Arab Emirates Ministry of Health. Cerner Middle East, Cerner Corporation Report.

Ghaleb, O 2012, A Glimpse of Pricing and Reimbursement in the United Arab Emirates. ISPOR Arabic Network Forum.

Ministry of Health (MoH) 2013, United Arab Emirates -Report from Hospital Build: Factsheet- Healthcare Services United Arab Emirates. Ministry of Health Economic Report.

Musaab, A. W 2014, Principles of Designing Adaptable Smart Computerized System. Retrieved on 6^th March 2016 from: http://earsiv.cankaya.edu.tr:8080/xmlui/bitstream/handle/123456789/360/44.pdf?sequence=1&isAllowed=y

Nuance Communications Inc (NCI) 2013, Dragon Medical Playing Central Role in Ambitious United Arab Emirates ‘Wareed Programme’. Nuance Communications Inc, Dragon Medical Case Study.

Pierre Ausoin Consultants (PAC) 2010, The Healthcare Market in the United Arab Emirates: A Whitepaper by Siemens IT Solutions and Services. Software and IT Service Industry Report.

The Economist Intelligence Unit (TEIU) 2015, Investing in Quality: Healthcare in the United Arab Emirates. The Economist Intelligence Unit Report.

United Arab Emirates Ministry of Health (UAE-MoH) 2013, Department of Nursing: Annual Report. United Arab Emirates Department of Nursing Report.

United States and United Arab Emirates Business Council (UAEBO) 2014, United States and The United Arab Emirates Healthcare Sector. Business Council Organization.

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