Strategic planning and management of healthcare in Saudi Arabia

INTRODUCTION

Strategic planning is that process in which a country creates a documented plan ahead of time where it will use moving forward for improving different parts of the economy, healthcare or other aspects in which the expected result will be the overall improvement of the country.¹ Strategic planning in the ministry of health (MOH) includes the activities used to set priorities, enhance operations, and prioritize resources and energy within the health organizations.² Health organizations have made numerous contemporary changes to their management method due to increased economic and technical factors. This has led to numerous changes to ensure health organizations can meet the standard requirements and optimal solutions to the numerous challenges. Globalization is considered the primary factor imposing challenges in the health sector around the world.³ The strategic planning and enhancement of management practices are present in both private and public organizations. Through strategic planning and management, health organizations can make necessary operations such as planning, analysis, assessment, and monitoring to ensure target achievement. These changes have also made it a necessity to enhance future planning to ensure the success of healthcare practices.³ This process involves planning on how to be well equipped for any changes that may happen in the future.⁴

According to Alomi et al there are numerous aspects of healthcare which are focused on when to develop a strategic plan for the healthcare sector.⁵ These include having a decision and financial structure that require necessary planning to ensure that they run expectedly. However, strategic planning in Saudi Arabia also requires the improvement of strategic management to meet the positively changing environment.⁵ Therefore, this paper focuses on investigating how healthcare organizations within Saudi Arabia develop and adopt strategic planning and management by focusing on the strategic planning adopted in its health sector. This will help understand different aspects that are involved in improving the health sector in Saudi Arabia. Moreover, we will focus on the suggesting recommendations which can be implemented in the Saudi Arabian health sector to improve operations, success, and strategic planning. We will also explore the strategic planning methods used in other countries to ensure extensive information can be used concurrently to improve other nations' health care sectors.

Strategic planning has six dimensional arms which include having a plan, plan development, plan implementation, responsibility of planning activities, governing board involvement, and physicians’ involvement as components of the strategic planning process. However, some studies in high-income countries suggest that the only three dimensions needed in achieving financial performance are having a strategic plan, assigning the chief executive officer for the plan, and involving the board.¹

As Saudi Arabia's population keeps on growing, several changes and improvements to the healthcare sector are taking effect to promote the mental and physical wellbeing of its citizens. In fact, in collaboration with the National transformation plan (NTP), the MOH has been tasked to deliver the recently launched vision 2030 for the kingdom of South Arabia. As such a transformation is sought, careful planning and changed are necessary to ensure that such a process is utilized efficiently.

METHODOLOGY

In this study, the electronic search strategy has been used in gathering information and data using various databases and platforms including CINAHL, Google scholar, MEDLINE, Cochrane library, pubMed, web of science, EBSCO and SCOPUS. We included various keywords including “strategic management” and/or “strategic planning” and/or “strategic planning in Saudi Arabia”. We used only accessible articles, which are written in English and was no older than 2005 to include in our extensive literature review.

THEORETICAL BACKGROUND

According to Alomi et al the MOH is responsible for determining and implementing health care and strategic planning within the health sector in Saudi Arabia. It is believed that it is an essential step in strategic management and planning concerning the health sector's development and success. According to a review of the international strategic plan in health care organizations, pharmaceutical care has been improved and updated in Saudi Arabia ion the recent years.⁵ This included some general strategies, initiatives, and projects that were to be put in place to improve pharmaceutical care in Saudi Arabia health organizations. These were developed after analyzing the ability of the health organizations to reach their goals at that time. Strategic planning was considered to select the health sector's main goals and develop policies of specific programs to ensure the achievement of those goals with proper implementation and follow up. Therefore, the MOH have the responsibility of acquiring data on the international health sectors to acquire insights on developing similar initiatives at both local and national health levels. The information is acquired from different countries with similar organizational goals and structures such as the WHO, British pharmaceuticals council, and the International pharmaceutical federation (FIP).⁵

According to Ginter et al healthcare organizations are now recognized to have a complex system within the society making it necessary to have a management system to help in the operational structure, to avoid future instabilities. Through the health ministry and private health organizations, the health sector can develop strategic management system for better operation and performance. The focus of strategic planning and management in the health sector is to ensure the best healthcare quality is provided within the region with regards to those systems. Moreover, rapid developments in this region require numerous research methods performed in succession to ensure that the information with the ministry is usable in its current form. This helps develop essential models and strategies that effectively ensure that the health sector does not lurk behind when changes come faster than expected.²

Strategic management practices are essential in the health sector where they require significant solutions to improve their performance. In Saudi Arabia, this issue includes the positively changing management dynamics of health organizations. This is considered a challenge to the health sector in Saudi Arabia since the changes happen faster than the time taken to develop the solutions to these challenges. The author utilizes questionnaires which involved top managers in the health sector. The private and public health organizations provide the MOH the information they require concerning the challenges they face within their administration and system.⁶ According to Alomran, one of the main reasons Saudi Arabia organizations have the tendency to cling to old management systems are fear of change, lack of proper strategic planning, and inability to change. Therefore, the primary focus of the strategic planning process involves actions and solutions that offer a remedy to the challenges that reduce the health sector overall performance and outcome.⁶

Lastly, the utilization of the information technology (IT) field is essential as our world shown how greatly it can be utilized in times of needs and pandemics. Even though IT modules can provide great efficient short term outcomes, it is considered unreliable due to the need for human factor monitoring and operation. As a result, long term strategies are essential in ensuring that the health sector does not stay for a long time without a policy governing them, thus making it easy to develop the other policies that change rapidly over a short period.⁷

DOMESTIC LEVEL

The Saudi Arabian MOH primary focus has been on the pharmaceutical care developed in the current decade. This strategic plan resulted from issues concerning the ability of the health organizations within Saudi Arabia to prevent diseases, patient care, and responsibility of the health care outcomes. However, these aspects of pharmaceutical care in the health sector have been challenged in the current world by numerous factors that have led to the inability to reach the standards of the required pharmaceutical care.⁸ Although the environment changes rapidly within the society, more attention is required from the MOH to ensure that these issues do not become a challenge to the ability to meet the health sector's goals.⁸ Moreover, the local organizations are also expected to implement national and international standards to help improve them to reach the expected standard by the MOH with pharmacy practices playing an essential role since they offer services to many individuals, thus substantial improvement is expected.⁶

NATIONAL LEVEL

The MOH offers strategic planning and management methods for the health organizations around the Saudi Arabia region. This makes it necessary for the ministry to work closely with both public and private health organizations to acquire information on the challenges being faced by the health organizations. These challenges then offer insights on how to develop solutions to the issues to improve the health sector's productivity and improve the ability to offer the services expected from them. In conjunction with the general administration of pharmaceutical care at the ministry of health (GAPC-MOH), the MOH in Saudi Arabia was given the task of developing strategic planning and improve management in the health sector.⁹ The administrative organization explores different issues such as management and improves them to better standards to ensure hospitals in the nation to be of the same level of other nations. This organization also has the objective of improving the pharmaceutical department in the nation's health sector. This illustrates that the organization's strategies after scrutinizing the current challenges that affect the health sector are implemented in all health organizations in the nation. This ensures some regulations and policies govern operations in the health organizations within the nation.⁹

The MOH and the GAPC-MOH have conducted numerous studies on the challenges that affect the health organizations within Saudi Arabia. This help in developing solutions that improve the capabilities of health organizations. This also improves the health sector's level at the international level by improving the health organizations in the nation to reach the expected targets. The organization's primary concern is on the pharmaceutical care that is concerned with offering solutions related to medication and preventing diseases.¹⁰ The organization, with the help of the MOH, conducts its research on the factors that may lead to the inability to meet the department's targets in offering health care and solutions that can be utilized accordingly.

DISCUSSION

2030 vision

Saudi Arabia's population is continually growing and increasing. It is estimated that its population will have older citizens, aged 60 to 79, by 2030. While the elderly population is expected to reach 4.63 million from 1.96 million, which was in 2018, this change will pose health challenges to the Saudi MOH if no strategic plans are made. Similarly, the general population is expected to grow from 39.5 million, 2018, to 33.5 billion by 2030.¹¹ With this increase in population, Saudi Arabia's MOH is determined to make further transformations to improve the healthcare system, particularly in areas of maternal and child mortality as well as in reducing communicable diseases. A need for transformation was also initiated by the gap present in the quality of service that patients received. This issue was because of the unavailability of pathways and steady procedures for a thorough treatment, and inadequate examination of patient outcomes and processes. The need for change was also triggered by the previous system that was more staff and resource-centric instead of being patient-centric in its orientation. Moreover, there were gaps in workforce capability and capacity, especially Saudi employees. The system lacked consistency, robustness, and failed to integrate digital information system to manage and measure activity levels. Also, the expenditure used in healthcare had to be adjusted to allow for Saudi Arabia's economic growth. With all these needs, the ''vision 2030'' was initiated.¹¹ The main transformation goal is to improve health, improve healthcare, and improve value. These are considered the three pillars of 2030 vision regarding the health sector.

Implementation

The National and new 2030 vision which was initiated two years ago by Saudi Arabia. Healthcare transformation will be happening on a multilevel stepwise method. Seven themes have been identified as the corner stones of the system. Those include, new care approach, provider reforms, financial reforms, development of governance, participation of the private and third sectors, development of workforce and development of digital health framework.¹¹

Three levels of value are facilitated by the first three themes. The focal point of the new model of care is enhancing personal value though care modalities and improvement of treatment at an individual level. The focal point of the provider theme is in improving utilization value at the intermediate level, either at a hospital, local health system, or clinical micro-system. The focal point of the financing theme is the allocative value by making sure that the intermediate levels receive maximum levels of resources based on their ability to benefit and the patient's needs. Of all the themes, financing plays the most significant role as it secures all the other forms of value. According to Dzau et al suggests that based on past experiences of health transformation strategies, financial and organizational changes are not enough to offer major improvements in outcomes unless accompanied by other changes that allow for effectiveness, efficiency, and responsiveness of health services and public health.¹²

The transformation strategies

Since 2017, the MOH has been making progress in formulating principal elements of its strategy. Three key policies seek to address the challenges they want to solve by emphasizing the first three themes. The first policy is the new models of care as the existing model had several flaws in how patients receive care. There were more hazards in healthcare facilities because of low safety standards and inadequate medical quality.¹³ Inevitable dissatisfaction among patients was built because of the prolonged waiting times. This was designed with the goal of promoting wellbeing and health; mental wellbeing, physical wellbeing, and social wellbeing; which is in respect to the world health principle that health is not just an absence of infirmity or disease but a state of social, physical, and mental wellbeing. Therefore, care is a key component of promoting health. This policy was created based on some policies; providing knowledge as part of treatment, empowering people to be in control of their health and wellbeing, assimilating the health systems from the viewpoint that Saudis have, keeping people healthy, and offering treatment in an outcome focussed and patient-friendly manner. There are six systems of care that have been prioritized; safe birth, keep well, urgent care, last phase, and chronic conditions.¹¹

Regarding provider reform policies, the first policy is increasing the use of the provisions of private healthcare. The second one is coming up with a third sector provision that will fill the gap that may arise from either market or government failure. The last policy is creating all the existing providers of the MOH through an initial cluster phase.¹⁴ The financial reform will be achieved through certain incremental steps; confirming the commitment to universal healthcare coverage, coming up with programs for health assurance, defining essential benefits package (EBP), formulating a system of supplementary health insurance, coming up with a broader role for private health insurers, payment mechanisms, and evaluating expenditure.

Scope and timeline of the transformation

Phase 1, building capabilities; this phase began at the beginning of 2018 and is currently underway, and it is expected to be complete by the end of 2020. Its focus areas are capability and capacity building, clinical systems improvements, and preliminary institution building. Most activities are coordinated by the MOH, particularly on the new models of care.

Phase 2, developing value and autonomy; this phase is anticipated to begin at the beginning of 2021 and be completed by the end of 2025. Its primary focus will be the robust and secure corporatization of key public units. More so, it will be concerned with the execution of healthcare policies and reforming systems and digital governance. Basically, it will re-purpose the MOH. This phase will offer the Saudis with the opportunity to buy supplementary health insurance (SHI).

Phase 3, strengthening choice and value; this phase is expected to begin in 2026 and be completed by the end of 2020. During this period, there are plans to extend NHI to residents, citizens, and visitors to Saudi Arabia. Values in the private healthcare sector will be facilitated through pushing for licenses.

Changing management

The changes proposed in the 2030 vision are transformational in its core. It involves changing the wider health system and the overall direction of the MOH. Furthermore, it alters the types of work, the purpose of the system, learning, duties, and the way work is done within the organizational and social processes. Therefore, it is happening in three multi-phases: level, dimension, and phase. More so, the changes will take place in the approach of an open system which cannot be completely controlled. On the other hand, there are two management approaches that have been proposed: action research and learning and the model of quality improvement. In addition, the change will happen both internally and externally.¹¹

International level

The international level includes strategic planning developed and implemented by health organizations around the world. This level includes large organizations, such as WHO, that are concerned with improving the entire health sector worldwide. It offers both financial and strategic support for health organizations in different countries. As such, the organizations' focus is not on a specific country or continent but to the entire world. The WHO is responsible for researching the issues that could cripple the health sector around the entire world and find solutions to it; they communicate them to the affected countries and offer ways for them to implement it. They also help the affected nations with strategic planning and financial help that will enable them to develop the necessary changes that will help safeguard the health sector around these nations. This strategic planning allows countries around the world to analyse the sector's issues and provide the necessary solutions to the problems challenging the sector. The international level offers training to the health organizations on how they can utilize technology to their.¹⁵ In this process, they can understand the main issues that can be solved before being an issue to the sector. The international level offers initiatives to the National levels by delivering training on the usage of the electronic prescription or computerized physician order entry (CPOE), hardware and software used in the health departments, and how to use electronic documentation. These features introduced help the health organizations around the world to have the ability to improve health organizations.¹⁵

CONCLUSION

The study shows that strategic planning and management are essential for the health sector since it involves continuous development of changes to improve the sector. These changes were derived from researching the current issues that affect the sector and develop solutions to them. The study also finds out that the MOH analyzes the future challenges that the sector could face and develops policies, programs, and initiatives focused on minimizing the effects of the future challenges on the sector.

Recommendations

Improving the relationship with the Nation and international private and public health organizations will help improve the amount of information that the ministry will get, thus improving the ability to develop the correct solutions for the health organizations. The changes should contain future analysis since the future should also be protected to ensure challenges that will be met later can be handled before they weaken the health sector in the country. The MOH should be concerned with the wellbeing of the health sector; thus, they should be involved in every change that is detected to ensure they are handled correctly.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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