Health care delivery system challenges are worldwide, with health expenditures often growing at a faster rate than gross domestic product (GDP) and real wages. Aging populations paired with increasing comorbidity burden strain already fragile systems that are suffering from health care workforce shortages that are only projected to worsen. The current approach to health care is simply not sustainable.
We are at a tipping point – either we take bold, decisive action to take the necessary steps to create sustainable health care delivery systems that better align incentives to adequately care for populations or we continue on our downward path, risking global security, jeopardizing economic stability, and worsening public health.
It is true there are case examples of successful health care transformation efforts, such as the integrated practice unit (IPU)-based care model of the Musculoskeletal Institute at Dell Medical School at the University of Texas at Austin, where their multidisciplinary team-based care has increased access and quality, or Brigham and Women’s Hospital’s Patient-Reported Outcomes, Value, & Experience (PROVE) Center, which not only conducts innovative research on patient-reported outcomes (PROs) but has helped implement PROs into routine clinical care. However, widespread transformation remains elusive.
At the broader health system level, courageous leadership to not only challenge but change the status quo – and do so efficiently – is needed. During my recent visit to the Kingdom of Saudi Arabia, I witnessed remarkable determination to put theories and ideas into action at King Faisal Specialist Hospital & Research Centre (KFSHRC) – and, most importantly, tangible steps area already being taken.
But what are the pivotal “ingredients” to the progress so far and ultimate success long-term? First, now that KFSHRC has transitioned from a government-owned entity to a non-profit foundation, the institution has a clear strategic vision of and definition of success. Simply, KFSHRC aims to deliver high-value care to patients and strives to be the best health system in the world. Outlined by the Kingdom of Saudi Arabia’s Crown Prince and Prime Minister, Mohammed bin Salman, and implemented by experienced hospital leaders, the organization’s clear strategy provides direction and helps stakeholders set meaningful and targeted goals. This has led to the implementation of robust measurement across the health system, including of
patient outcomes and experience. Additionally, efforts to accurately determine cost at a granular level are underway. It was clear that all hospital team members not only knew the strategy and overarching goal but were passionate about accomplishing it. While more changes will occur in the days, months, and years ahead, in an industry that typically takes multiple years for any amount of change, KFSHRC has taken days to months for many substantial initiatives.
Second, KFSHRC blends the expertise and experience of outside leaders and physicians who have succeeded elsewhere outside of the Kingdom with local talent; this allows for leaders to drive progress based on their prior experiences with an understanding of local norms and traditions. For example, the CEO is Dr. Majid Ibrahim Alfayyadh, a native of Saudi Arabia who is an American-trained pediatric cardiologist and electrophysiologist, and the Deputy CEO is Dr. Bjorn Zoega, an Icelandic orthopaedic spine surgeon by training best known for turning around Karolinka University Hospital as its CEO into a top 10 hospital worldwide. Both are very active and easily visible throughout the institution, reducing the common “ivory tower” C-suite feeling amongst employees. It was clear through my conversations with physicians and other KFSHRC personnel that this leadership pairing of two physicians with both local and global experience inspires confidence in the workforce that the patients’ and their best interests remain front and center each day despite the massive transformation efforts underway.
Third, KFSHRC is unafraid to lead care innovation efforts, both at the system level but also at the individual patient level. The institution performed the world’s first fully robotic heart transplant, continues to build out its CAR T-cell and gene therapy programs, and houses a large hospital-at-home program. While my conversations demonstrated a commitment to patient safety, it was equally as clear that the workforce takes pride in pushing the boundaries of healthcare using the latest technology, all while educating future physicians and conducting research. The excitement around “being the first” in many cases was palpable, and it almost felt that
employees felt nothing was out of reach. The future of health and health care requires taking calculated risks, and it became clear during my visit that KFSHRC would be an institution at the forefront of this bold push.
Overall, I walked away encouraged by KFSHRC that “real” change in health and health care is feasible. The institution’s aspirations grounded in a “nothing is impossible” attitude and a clear strategy with leadership to make it happen breeds confidence across stakeholders, which clearly stood out to me during my visit. And – as expected – with any undertaking of this magnitude, there are challenges; however, this has not stopped progress thus far. The ultimate test will be what is accomplished, and only time will tell.
Undoubtedly, there are – and will be more – learnings that can be shared between world-renowned health care institutions in the U.S. and KFSHRC and vice versa; all of these will help patients worldwide, and this is what we should care about most. I returned home re-energized and eager to continue my work in driving health care transformation within the U.S. I am an eternal optimist and believe the best of health and health care is yet to come.
The opinions, thoughts, and ideas expressed in this article are those of the author only
and not necessarily those of any employers or institutions of which he is affiliated.
Disclosures: No funds were provided for this article.
David N. Bernstein, MD, PhD, MBA, MEI is a resident physician at the Harvard Combined Orthopaedic Residency Program at Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Boston Children’s Hospital and a Senior Researcher in health care transformation at Harvard Business School. Follow him on X (formerly Twitter): @DNBernsteinMD.
