This document will provide an analysis for expanding the emergency and rescue (E&R) department at a large medical complex in the capital city of Saudi Arabia into a trauma centre with 2-3 years(The Business Year, 2015). For the sake of convenience and anonymity, this medical complex will be further referred to as Hospital A. The tools used to carry out the analysis are: SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) as an overarching system of marketing analysis; McKinsey’s 7s, to examine the strengths and weaknesses part of the SWOT; and PESTLE analysis to evaluate the opportunities and threats within the SWOT (Valentin, 2011).
Hospital A is located in the capital city of Saudi Arabia: Riyadh. This is the city with the highest population in the country, with 7 million people living within the city. In addition, the average number of visitors to the city was estimated to be 5.4 million in 2014 (Saudi Arabia Central Department of Statistics and Information, 2014). The number of road traffic accidents which occurred in 2014 in Riyadh accounted for one fourth of all accidents in the country (Ministry of Health Statistics Book, 2014). This is an extremely high ratio. There are 21 hospitals within the city, but only 21 ambulances available (Health Statistical Year Book, 2013). Hospital A’s existing emergency department has 81 beds available. This is clearly not enough to serve such a huge population, and the quality of care provided is in danger of being severely compromised.
Healthcare development is believed to the Saudi’s government priority at all levels. Consequently, healthcare quality and availability in the country has significantly improved in the last two decades. However, the Saudi Arabian healthcare system is inundated with a number of serious problems. Firstly, the number of healthcare professionals of Saudi origin is very low, which combined with a high demand placed on services, exerts a great pressure on the healthcare system. Secondly, the type of diseases affecting Saudi society is constantly changing, therefore it is difficult to adjust the provision of healthcare services accordingly. In addition, it is difficult to access certain healthcare facilities and the information system is not developed enough for the patients to know what services are available and where. Last, but certainly not least, the use of electronic health startegies is not yet widely popularised and implemented across the country. (The Economist Intelligence Unit, 2014).
Hospital A is considered to be one of the busiest and most highly trusted in the capital city (O’Kane, 2011).
PESTLE is an acronym for political, economic, socio-cultural, technological, legal and finally environmental aspects of a given project (Naylor & Buck, 2013). The PESTLE framework helps to assess the context, within which the project is to be developed, and the impact it may have (Miner, 2006). The above tools will be applied to determine the external factors which might have a long-term or short-term impact on the objective of expanding the hospital’s E&R department into a trauma centre.
According to William (2008), the Kingdom of Saudi Arabia (KSA) is a considered to be one of the most economically stable nations in the world. In addition, the KSA is one of the fastest economically-growing countries in the Middle East, and the world’s largest oil exporter. The country’s economy has been boosted significantly by oil exports (Duggirala & Anantharaman, 2013) and this has allowed the country to gain high revenues, which are used to support many development projects within the country, including the healthcare sector (Househ et al., 2015). According to the Central Department of Statistics and Information, the government’s plan to develop the health care system has been clear over the last decade, as the total expenditure on health care dramatically increased from 3.4 billion dollars in 2003 to 8.7 billion dollars in 2014. 85.1 million dollars of this governmental funding is allocated to Hospital A, which has allocated 7% of its budget to establish the trauma centre (Balkhair, 2014).
The fact that the KSA is a tax free country may encourage private investors to become involved in the health care development plan of the country (Girijasankar & Ramprasad, 2011). The two Islamic holy cities (Mecca and Madina) attract millions of visitors to Saudi Arabia, as every year an average of 25.3 million of people perform pilgrimages (Hajj and Umrah) to these two holy cities. This means that being a well-established health care network in the Gulf region puts Saudi Arabia in an extremely good market position with a potentially high demand for emergency services (Central Department of Statistics and Information, 2015). The number of people coming to the country for religious purposes has increased dramatically in the last decade. The total number of visitors increased from 22.4 million in 2010 to 26.2 in 2014 (Central Department of Statistics and Information, 2014). There is an enormous need for a trauma centre with sufficiently large capacity to accommodate the accidents that may occur during the pilgrimage (Ministry of Health Statistics Book, 2015). The 24th of September 2015 recorded one of the most tragic accidents in the history of the country. At least 2,236 pilgrims passed away as a result of a crowd stampede which led to suffocating and crushing of the victims. This happened during the annual Hajj pilgrimage in Mina, in the Mecca region. The number of injures was reported to be 4,554 people (Ministry of Health Statistics Book, 2015). It was reported by Karim, Ralph and Hanna (2015) that the hospitals were not able to treat all of the injured people, which was a reason for the death of approximately 100 people. At least 700 injuries were dealt with in hospitals outside Mecca, out of which 25 injuries were dealt with in Hospital A’s emergency department. Having sufficient numbers of well-equipped trauma centres has proved to be an urgent requirement in light of this disaster, and as a result the Saudi government has started to invest more in the health care disaster system, assigning 1.2 billion dollars to this project. The governmental plan covers expanding hospitals around the country, and includes Hospital A. In addition to expanding infrastructure, the government has decided to invest in a skilled workforce, increasing the number of scholarships for medical staff by 5% by the end of 2017 (Mohammed, 2015). This is mainly to develop staff specialising in trauma care. In October 2015, Hospital A received 12 million dollars to establish a trauma centre (Al-Ahmadi, 2015).
Another phenomenon which places increased demand on the existing emergency departments, and calls for developing more trauma centres in the country, is the dramatic increase in the number of road traffic accidents (RTAs), and thus the increase in the number of people injured or killed in such accidents.
According to the Central Department of Statistics and Information, 598,320 road traffic accidents occurred in 2014: an average of 1,614 each day. There has been a remarkable increase in the number of accidents, which has risen by more than 23.1% from 2009 and by 9 % from 2011. In 2009, the Ministry of Health recorded 484,790 accidents, an average of 1,330 a day. The figures grew in 2011 to 500,220 accidents, with an average of 1,375 a day. The capital Riyadh led in terms of the number of accidents, with 28% of the country’s traffic crashes in 2014. Authorities have launched campaigns to control this by promoting a more positive traffic culture, but regulations are being violated by speeding drivers (Ministry of Health Statistics Book, 2014). From 2009 to 2014, an average of 25% of accident-related deaths happened in the capital. Having such a large number of accidents creates numbers of casualties which cannot be dealt with sufficiently with the existing number of trauma centres and in the conditions that are present there (Al-Ibrahim & Al-Naami, 2014). Consequently, the need for a large and sufficiently equipped trauma centres is urgent.
Technology in healthcare has become an obligation as great as antibiotics, as MRIs, multi layered X-rays, and even robotic surgery facilities have been released onto the market. It is almost obligatory for hospital managers to keep abreast of the emerging new technologies in healthcare (Peabody, 2013). Hospital A, with its extensive budget, can afford the most advanced technologies. The quality and the quantity of the trauma centre’s medical instruments have seen a dramatic enhancement since 2010, when the government took responsibility for purchasing technology for hospitals (Balkhair, 2012). Advanced Continuous Passive Motion (CPM), Orthotic, Prosthetic and Pulmonary artery catheters became available after the government’s decision. The overall expenditure on technology provided in the emergency department increased from 7% in 2009 to 8.4% in 2014 (Alshahrani & Alsadiq, 2014).
On the other hand, from 2010 it has benn the hospital’s responsibility to arrange contracts with private companies to supply the centre with the medical equipment, starting from the basic necessities such as beds, to more technologically advanced and complex machines like MRIs, and multi- layered X-ray instruments (GULF Writers & Dreamdrive Digital, 2014). This is a new setting, as previously it was the Saudi Ministry of Health which was responsible for providing the technology for Hospital A in general and then deducted the cost from the annual fund (Ministry of Health, 2013). This change allowed more flexibility in terms of being selective with the type of technology needed, not to mention the Ministry’s much greater purchase power, which allowed for more advantageous price negotiation with the equipment providers (Nuviun Digital Health, 2014).
One of the examples of the above-described flexibility comes from 2012, when Hospita A had a contract with Siemens AG to provide certain medical equipment (triple lumen catheters, ventilators and IV fluid) to the emergency department with annual maintenance provided by the company as a contract condition (Alshahrani & Alsadiq, 2014).
The law in Saudi Arabia is drawn from and based on the Islamic Sharia law. In fact, the Qur’an and the Sunnah form the country’s constitution (Otto, 2010). This is a very strict system of law, which, amongst other aspects, enforces segregation of sexes in the public sphere, prohibits criticism against the ruler, and prohibits religions and religious practices other than Islam. In addition, it implies discrimination against non-Saudi and non-Muslim residents. The Article 27 (Welfare Rights) of the Saudi Arabian constitution states that the Government provides a guarantee to every Saudi citizen that their rights will be protected in case of illness, disability, emergency and old age (Bagad, 2008). The law clearly favours Saudi citizens in terms of access to the social security and support system, whilst non-Saudis and non-Muslims on one hand must comply with the strict laws of their host country, yet on the other cannot take advantage of these otherwise generous and charitable laws. For example, they must rely solely on private institutions if they need or want to access a health service, for which of course they must pay. This can make the manpower situation quite difficult, as non-Muslim healthcare specialists do not always wish to work in the country while there is still a shortage in provision of the skilled Saudi workforce. The health laws oblige the Government to provide free primary, secondary and tertiary healthcare to national citizens, and to manage public health (Khalid, 2009).
Politically, there have been many threats to the country’s stability since January of 2014, when the Islamic State in Syria and Iraq (ISIS) took over the control of certain parts of Syria and Iraq. ISIS is considered to be one the greatest threats not only to the political stability of Saudi Arabia, but, in fact, to the political stability of the world, posing the threat of another global war. In addition, due to Saudi’s strictly mono-political system and merciless dealing with any opposition, as based on the Islamic law of allegiance, questioning the ruler’s legitimacy and criticizing royal family actions is strictly prohibited there was no ’Arab Spring’ in Saudi Arabia: however, ISIS seek to ‘become the protectors of Islam’s most sacred sites in Mecca and Medina that are at the centre of Hajj’. This certainly undermines the Al Saud royal family’s legitimacy, who deem themselves the ‘Custodians of the two holy mosques’ (Hashim, 2014). A potential military operation between the Al Sauds and ISIS may prove to be detrimental to the Kingdom.
On top of this, the KSA is currently involved in another war; i.e., in Yemen, fighting the rebel Houthie groups. The war started in 2015 and has cost the country over 400 lives. Apart from the death toll, this war has also caused a significant financial shortfall in the national budget. Over 200 billion dollars were spent between January and September 2015 alone (Asa et al., 2015).
Government spending on military systems increased dramatically from 2.3 billion dollars in 2014 to 11 billion in 2015. The expenditure on other governmental sectors, including amongst others on the education and healthcare systems, might therefore see a dramatic fall due to the possible need to invest in the military sector in the case that there is escalation of the conflict. The government already declared a new austerity plan in December 2015, which is expected to reach many sectors of the country by 2018 (Robert, 2015). Further, the threat of war may lead foreign staff to flee the country (Blinder, 2014).
When it comes to the economic analysis, rising health issues and tight public budgets over the past four decades have led decision makers to consider the privatization of the healthcare system in the country by 2020 (The Economist Intelligence Unit, 2014). Despite some positive elements of privatization in general, the privatization of healthcare services is considered to be one of the more controversial possible actions and one which might affect the establishment of the Trauma Centre at Hospital A (Al-Ahmadi, 2014). On one hand, it is considered to be a threat to the objective. This is mainly because privatization in healthcare generally reduces quality of care, because private companies seek solely to minimize costs and maximize profits. With 54% of the costs of healthcare coming from the cost of wages/salaries, the only way to cut this cost down is to cut down on staff, which results in a decrease in the quality of care (Central Department of Statistics, 2014). This is the case in the majority of hospitals in the United States. The privatized US health care system has been ranked the worst in the world by international experts (Kane & Villa, 2013). Therefore, in the case of Hospital A, there is a threat to the establishment of the trauma centre from the possibility of privatization. Also, it is very likely that the hospital will in this case not be attractive to experienced staff due to low wages and/or unfavourable conditions of work.
On the other hand, it is also argued that privatization of the health care system might spark competition between private health care providers, which might lead to enhancements in the quality of the health services in the country (Albert, 2009). Competition between private health care providers might include offering high salaries for experienced staff and a possible expansion of the trauma centre, not to mention securing the most advanced technology in the hospital.
The McKinsey’s 7s is a tool which is helpful in recognizing and analysing certain elements within an organization. It provides a deeper understanding of the overall condition of the analysed company and pinpoints the areas that might need to be improved or changed in order for the project to be successful. The ‘7s’ stand for strategy, structure, systems, shared values, skills, style and staff. These elements are then further divided into ‘hard’ and ‘soft’ components. Strategy, structure and systems are deemed to be the ‘hard’ elements, whereas shared values, skills, style and staff are classified as ‘soft’. It is assumed that the ‘hard ‘elements are relatively easy to identify and change or influence if necessary, whereas the ’soft’ elements are more difficult to determine and are often influenced by the culture of the region (Hanafizadeh et al., 2011).
The hospital has defined expansion as its ultimate goal. Transforming the existing Emergency Department into a trauma care centre is in line with this strategy. The CEO of The hospital has clearly expressed his intentions, as the land for the new development has already been acquired. If we evaluate the hospital strategy through a strategic management process, there is internal and external support for the change, and this intention of expansion has already been executed (Ministry of Health Saudi Arabia & Ministry of Planning, 2010). The hospital’s budget spent on scholarship for the trauma centre medical staff has dramatically increased in the last five years, from only 7% in 2011 to 11.6% in 2014. In addition, the expenditure on advanced medical equipment saw a dramatic rise from 4% of hospital A’s budget in 2011 to 7.3% in 2014 (Alosaimi, 2014).
The Hospital A complex consists of five hospitals and two centres; a general hospital, maternity hospital, paediatric hospital, dental centre and a kidney centre. The hospital also provides medicine, surgery, cardiology, neurology, ENT, dental, gynecology, orthopaedics, obstetrics, trauma and burn related treatments (Almazen, 2013). When it comes to organizational hierarchy, Hospital A has a pyramidal general hierarchy; its departments work in groups, and also hierarchically form a pyramid. A group usually consists of interns, residents from 1st year and 2nd year, registrars from 3rd and 4th years, specialists, consultants and a head of group, and all teams work under the direct supervision of the head of department. These teams are formed on a daily basis, and upon referral of a case or patient, every member of the team is involved in the consultation process, but the final decision for treatment is decided by the consultant (Aldossary, 2013).
Every department of the hospital has its own chain of command and works under the supervision of directors, followed by the secretary and assistant director. When it comes to management of finances, there is a statistics department which handles financial affairs, while the administrative department is responsible for all human resource issues. Administrators are also responsible for communication and management of administration matters (Gandhi et al., 2006). In addition to the administration department, Hospital A also has in its structure an independent media centre responsible for record keeping, advertisement, media management and health education. In the hospital, departments work with Quality Strategic Planning and Total Quality Management Units to ensure, monitor and control quality standards (Totten & Tiwari, 2012). Furthermore, these units work to reduce costs, improve efficiency, and provide high quality healthcare and satisfaction to patients. In this regard, hospital A consistently initiates Performance Improvement Projects (PIP) and has also defined Clinical Practice Guidelines (CPG) for medical staff to keep them on track with qualitative service delivery. Given the system at the hospital’s emergency department, the chances that ospital A’s trauma centre can become the leading hospital in the KSA are very high.
Hospital A is a public sector institution serving the community with state of the art medical facilities, and is among the pioneer institutes in the Kingdom with the best healthcare services (Abededdin, 2013). The environment at Hospital A provides safe and distinctive healthcare through excellent management and qualified staff relentlessly working towards continued professional development. Hospital A holds an excellent reputation, team spirit, respect among patients, and holds the customer values of patient as of first importance. Its aims and objectives are to be the number one trauma centre in the Kingdom, reflecting a positive environmental analysis.
Hospital A was established in 1956 with a vision to provide the best healthcare in the Kingdom of Saudi Arabia. Considering fundamental values, Hospital A was established with a goal of always putting the patients and their needs first, along with respect for the individual and their rights. The corporate culture of the hospital triggers transparency and mutual respect among workers, which encourages employees to work with team spirit. In addition to this medical practice, Hospital A’s values are aligned with the Islamic religion, and with the KSA’s laws and regulations, leading to the expectation that its trauma centre will have comprehensive shared values and the potential to shine in terms of performance (Alhajery, 2013).
During the decision making process and consultation, every member of the team is enabled to participate in the procedure and treatment, ensuring participation, but only the consultant has the authority to make decisions, ensuring leadership. So, both participation and leadership are practised at the same time. Employees at the hospital are not encouraged to compete with each other; rather they cooperate with each other: for example, if the intern or resident is busy, then the registrar can perform the task, while in the absence of consultant, a specialist is the senior staff member most responsible and most qualified to make decisions. So, the working style at Hospital A is cooperative and participatory with effective leadership, which is quite sufficient to achieve excellence (Almarzouqi, 2012).
Lack of national healthcare professionals is considered to be a great obstruction to the improvement of the country’s healthcare system. A high rate of instability in the workforce can be caused by the fact that the vast majority of health staff is foreign. Out of 248,000 medical staff in Saudi Arabia, there are 125,000 foreign, which is more than half of total workforce. In the case of Hospital A’s emergency department, a great proportion of the workforce is formed by foreign workers (41.4%). This is mainly due to the relatively low salaries in Hospital A compared to private sector hospitals (Almutairi, 2015). This is considered to be one of the potential weaknesses which hospitals around the country are faced with. In the case of a crisis occurring, the country may rapidly lose its healthcare workforce, because it is highly likely that migrant healthcare professionals will flee the country. If this is the case, then Hospital A’s trauma centre will be in danger of not being able to proceed. The best solution which couold be taken by the centre’s decision makers is to encourage local citizens to train and take up healthcare emergency services jobs. Hospital A’s advertising team aims to provide awareness to Saudi residents, by showing the possible impact which a lack of national staff might have on the city, and to encourage young people to be a part of the solution.
Lack of a skilled national workforce is considered to be one of the main reasons behind Hospital A employing a significant number of foreign staff instead of locals, in order to cover shortages in Saudi staff. This shortage is believed to be due not only to the moderate salaries offered (as mentioned above), but also to the low number of educational and training centres, including medical colleges and universities, in the country (Alshammari, et al., 2014). However,the Saudi government has invested significant resources in order to teach and train Saudis in the healthcare professions. Since 2002, a significant number of healthcare institutes and colleges have been opened by the ministry of health. In total, there are 73 medical colleges and 4 institutes were opened all over the country. On top of that, training plans aim mainly to substitute the enourmous migrant workforce with qualified nationals in health sector. In the case of Hospital A, staff of Saudi origin is involved in medical programmes inside and outside the country to enhance their experience and knowledge. Another incentive offered to those interested in medical careers is the vast choice of scholarship opportunities offered by the government in the last 5 years (Al-Dakhel & Almarzouq, 2015).
The aim of this assignment is to discuss various external and internal factors which may have either positive or negative impact on the project to establish a new trauma centre at Hospital A. The objective of building the trauma centre at a Hospital A has been analysed using the SWOT, PESTLE, and Mc Kinsey’s 7s techniques. This has provided me with significant insight into the ways in which I could potentially contribute as part of HOSPITAL A’s management to achieve the objective.
I think that the area in which I could provide the most valuable contribution is to be a part of Hospital A’s programme of advertising the careers and opportunities available at the trauma centre to high school graduate students, in order to convince them to take up a career in medicine/nursing and to specialise in trauma care. This will decrease the centre’s dependence on foreign staff. My contribution will involve delivering presentations in medical colleges and universities associated with Hospital A. The aim of these presentations is to provide a clear picture of the working environment of a trauma centre, and the potential benefits of being part of the trauma centre’s team. According to a survey carried out by the University of Fahad, 67% of medical undergraduate students believe that working in a trauma centre is one of the most difficult jobs (Almazroa, et al., 2013). The students need also to be aware of the fact that 55% of the Saudi healthcare workforces are foreigners, and in the case of any crisis threatening the country, hospitals around the country may face a workforce crisis due to the foreign staff retreating to their home countries.
Another contribution which I believe I could make is delivering the values that I learnt whilst being a student in the UK. This would help in producing a better work environment. For example, there is a lack of harmony and co-operation between the foreign and national staff, due to the fact that the majority of the foreign staff are non-Arabic speakers with different traditions and religions. Moreover, a survey conducted by the Almalik Saud Universities shows that 55% of national staff have either low or no interest in making real friendships with staff of other nationalities (Almazroa, et al., 2013). My experience of being a student in the UK has provided me with a great opportunity to experience co-operation and positive coexistence amongst people of different origins, religions, nationalities and races. I believe that sharing my positive (albeit as challenging as it might be for the traditional attitudes present within the existing workforce) experience will inspire the trauma centre board of managers and decision makers to incorporate and embrace the values I have come across in the UK. This may help to make the working environment more inclusive and equal, strengthen the shared values, and consequently make the work environment better. This will eventually play a significant role in leading national graduates to join the trauma centre’s team.
Being able to explore personal and team motives to create a vision of success or to accomplish a change is considered to be one of the most important characteristics of a good leader (Schein, 2010). The ability to assess the team’s processes and outcomes critically is one of the most important skills any leader should possess in order to achieve a shared goal. In addition, continuous personal and professional development, as well as continuous evaluation of the team’s collective characteristics and the individual needs of its members, is required for an effective leader (Rouse, 2009).
I believe that my leadership skills have been enhanced since I started the course, and in more than one way. I think that my rapport with the medical staff will be better, as I have experienced and learnt that one important aspect of being a successful leader is the ability to develop and maintain a positive rapport with colleagues (Chambers, 2007). According to Northouse (2009), leadership is strongly based on taking the initiative and being able to influence the people around you. These skills do not only apply to those on the top of the organizational hierarchy. Taking the initiative may be considered as common sense by many in theory, but when it comes to practice, it can only be seen in true leaders (2012). Showing initiative is a feature which any leader should necessarily possess. I believe that my capacity to show initiative has been enhanced since the beginning of the course. I have already produced certain proposals to offer to the trauma centre’s decision makers on how to achieve the goal of expanding it. One of these is providing a full project plan to the Saudi Ministry of Health showing the impact of expanding the trauma centre on decreasing the level of unemployment in the city, by means of providing both jobs and training programmes.
Co-leadership skill, in my view, is the main leadership skill which I need to develop further. I imagine that it might be difficult for me to collectively reach a decision: especially where my co-leader(s) may disagree with the ideas, visions or proposals I may have. I could overcome this difficulty by further reading, and by observing other leaders in their decision making process. One of the sources which I found quite helpful in strengthening my understanding of the shared leadership skill and leadership skills in general is ‘Leadership: theory and practice’ by Peter Northouse (2012). This book provides great insight into what skills an effective leader should obtain. Case studies were also provided in the source to make the concepts and theories more understandable and credible. Moreover, practice was provided where the reader had the chance to apply the theories learnt.
I must develop the qualities necessary to make informed and reasonable decisions, considering when to consult my team members and when not to interfere with the decision making process. Considering Hospital A’s decision making strategy, this norm may go against the principles of Hospital A, but in turn it promotes the democratic norm enforcing positive performance and involvement. I consider this skill to be one of those which I need to develop as a leader. I think that the best way of developing this skill is by further reading and involvement with other leaders (Nature and Context of Organization, 2014). In general, so far, I have gained a number of qualities and skills as a leader and as a person during my master’s degree (Casey et al., 2013).
|INTERNAL ORIGIN (Organisation attributes)||Strengths Strong values Corporate governance Decision making mechanism Political will Strong leadership Extensive clientage Available budget||Weakness Lack of integration Lack of medical Professionals Lack of skills|
|EXTERNAL ORIGIN (Environment attributes)||Opportunities Buyer and supplier power Competition Ministry of Health objectives alignment Pioneer and busiest medical city Top level medical facilitator||Threats Stakeholder mismanagement Buyer and supplier power Competition Political threats from terrorist groups Possible privatization of healthcare|
Figure 1 SWOT analysis
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