Guest Post: Transforming an Abu Dhabi Specialty Hospital

by Ronald Lavater on April 16, 2014

Ron Lavater

From 2009 until a few months ago, I had the honor of serving as the Johns Hopkins-appointed CEO of Corniche Hospital, a bustling maternity facility in Abu Dhabi. Reflecting back on my time there, I recognize our work as a useful case study on how teams of experts from different parts of the globe, from both the public and private sectors, can collaborate around making a very good health care institution one of the best in the region.

This, of course, required navigating a largely unprecedented blend of cultures, medical practices, organizational styles and financing methods in order to raise health care standards to the highest possible levels, especially in a region where relatively few hospitals have yet achieved them.

Corniche Hospital opened at its present site in 1984, and went on to become the busiest tertiary maternity and neonatal service hospital in Abu Dhabi, with close to 9,000 births and 1,000 neonatal intensive care unit (NICU) admissions. The hospital also provides some 120,000 outpatient visits, 25,000 urgent care visits, and 12,000 inpatient admissions for its specialties of obstetrics, gynecology and neonatology.

Corniche Hospital is owned and operated by the Abu Dhabi Health Services Company (SEHA), a quasi-governmental entity. Corniche’s collaboration with Johns Hopkins Medicine began in late 2008 with the signing of a five-year management agreement. At that time, the hospital’s reputation in the community was positive, although SEHA recognized that Corniche needed advancement in several key areas, including evidence-based clinical practice, quality improvement, physical facilities and management practices. An experienced team of Johns Hopkins executives assumed four key administrative positions at the hospital (chief executive officer, chief operating officer, chief medical officer and chief clinical officer). From the beginning, our mandate included establishing a plan not only to transform Corniche Hospital, but to smoothly transition direct management of the hospital back to SEHA in a sustainable way that prioritized developing local talent.

Our collaboration addressed changes in every aspect of the hospital, including people, processes and physical plant. For example, we upgraded the 50-bed NICU with state-of-the-art equipment, and doubled its physical size, adding proper spacing between patients, and providing for 14 more beds. We addressed patient flow by establishing an off-site women’s health center, bringing services closer to our patients. Together, we accomplished these and other projects, including much-needed medical technology additions and upgrades, on plan and on budget.

In patient care, the challenge was to establish best practices that were compatible with local culture, as well as instituting training and mentoring programs. We brought in a stream of world-class clinicians to provide seminars and classes, to work with Corniche Hospital staff to establish and codify new practices, and to conduct rounds alongside staff to facilitate knowledge-sharing. We emphasized embracing a culture of safety. We joined the Patient Safety Net reporting system run by the University Hospital Consortium and adapted locally many of the established Johns Hopkins patient safety programs, such as administrative patient safety rounds.

Image Credit: Ahmed Kutty/Gulf News

We expanded subspecialization clinical services in fetal medicine, assisted reproductive services and maternal medicine. We added respiratory therapy and a clinical pharmacy in the NICU, and strengthened our high-risk obstetrics, lactation, diabetes, dietetics, parent education and physiotherapy areas. As a tribute to these improvements, Corniche Hospital’s medical team safely delivered the UAE’s first live sextuplets, drawing on the skills of more than 25 staff members from a range of specialties.

We also expanded our efforts beyond the four walls of the hospital to have an impact in the community, putting public health initiatives on the management agenda. The hospital recruited Abu Dhabi’s first hospital-based public health director, and developed the first sustainable newborn car safety seat program in the Gulf region. Today, Corniche has distributed more than16,000 infant car seats to parents, who were also educated on the safety benefits of infant car seats. Other public health campaigns focused on pre-pregnancy wellness and screening for cancer, adult diabetes, and newborn audiology and congenital heart disease.

Recruiting top-quality clinical staff is challenging for most hospitals, but when 97 percent are expats from around the world, it’s even more difficult. To address that challenge, we mapped out a plan to develop clinical training programs around our core competencies, creating a pipeline of future caregivers. This strategy also linked to our strategy for developing Emiratis as clinical providers, to build a local talent base.

Corniche Hospital became the first facility outside of the United Kingdom to be recognized by the prestigious Royal College of Obstetrics and Gynecology for providing advanced training skills modules in maternal and fetal medicine. We established a specialized NICU nursing education course that allows nurses to complete a six-month neonatology nursing certificate program recognized by the local licensing agency. We also inaugurated a bachelor’s of applied science in midwifery program in partnership with the Higher Colleges of Technology of Abu Dhabi, an 18-month program that is the first of its kind in the UAE. Working in tandem with another Johns Hopkins-managed hospital in the UAE, Tawam, we created a three-year neonatal fellowship. And, we established a new obstetrics and gynecology residency program recognized by ACGME International.

(from left to right) Bassam Sayed, COO; Judy Lee, M.D., CMO; Lynda Mikalauskas, CCO; and Ron Lavater, CEO accepting the Circle of Excellence Award

All of these changes have helped lead to a string of prestigious regional awards for hospital staff in recent years, including Best Hospital from SEHA, and Excellence in Patient-Centered Care from the Arab Health Awards.

Meanwhile, the project had all along been laying the groundwork for the smooth exit of Johns Hopkins from the daily management, so SEHA and local managers could assume leadership of the hospital. With proper planning, and a great deal of communication that included town hall meetings, that transition went off without a hitch at the end of December. Though it may sound unusual to say it, I’m very proud of having worked myself out of a job—it’s the ultimate measure of our success—and I know my colleagues feel the same way.

2 Comments

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Comments

Paul Gardetto April 26, 2014 at 9:29 pm

Ron, thank you for your tremendous support to our troops stationed in UAE.

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Mark Schnitzer April 16, 2014 at 2:55 pm

I am sure the hospital staff are sorry to see you go but proud of what they accomplished with your inspiration and leadership. No doubt there are still larger projects in your future.

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