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Meeting the complex healthcare needs of the world’s population
By Rakesh Suri, MD, D Phil, CEO, Cleveland Clinic Abu Dhabi
‘The mission of Cleveland Clinic Abu Dhabi is to provide better care of the sick, investigation into their problems, and further education of those who serve.’
The mission statement of Cleveland Clinic, drafted nearly 100 years ago, helped to guide the work of doctors at a four-storey outpatient building in Cleveland, Ohio, when it first opened its doors to patients in 1921. Today, it remains a touchstone for more than 50,000 caregivers in an international network that includes our coordinated, multidisciplinary hospital in Abu Dhabi. The statement’s clarity and simplicity has proven to be an essential point of focus across our global footprint, even as our industry has faced a growing level of complexity and range of challenges.
Keeping a clear central focus – reminding ourselves every day that we are here to serve our communities – has been one of the main success factors in establishing Cleveland Clinic Abu Dhabi as the first patient-centred complex care hospital to operate outside of the US. I would highlight four other key factors that have played a role in our development:
Understanding these success factors – and in particular how these align with today’s population healthcare management challenges - provides an insight into how we can build a new model for global healthcare delivery.
Healthcare management – serving the needs of the population
There are three key dynamics that made the development of Cleveland Clinic Abu Dhabi possible.
The first is the need within the region for complex care closer to home. With a growing population, the UAE was actively looking for ways to reduce the need for patients to travel overseas for treatment.
Second was the vision of the leadership of the UAE, who saw the importance of bringing a world-class institution to the UAE.
Finally, the strength of the partnership between Mubadala and Cleveland Clinic in the US provided the necessary foundation for us to grow our service offering sustainably.
As an organisation, we take our responsibilities very seriously, as we use all our tools – experience, expertise, technology, research, and innovation – to address the needs of our patients. The benefit of an integrated healthcare network is that patients can walk into any one of our facilities, anywhere in the world, secure in the knowledge that they will receive the highest possible quality of care from 57, 000 of the most connected minds in medicine.
Encouraging technological innovation in healthcare
Connected devices mean that preventative medicine will become an increasingly important tool in the fight against disease. People are more mobile than ever and, as technology develops, they will be able to access diagnostic and advisory services from leading medical professionals, wherever they are in the world.
These advances provide us with the opportunity to move toward a new model of healthcare, one that enables providers to use their resources and expertise to encourage the whole community to live healthier lives. We can detect problems earlier and encourage behaviours that reduce the risk of illness and infirmity in the long-term, thereby preventing disease. We can also intervene remotely at the very earliest stages of illness facilitated by sophisticated remote cardiac monitoring that we currently use at Cleveland Clinic Abu Dhabi and have deployed throughout the region.
In the UAE and wider Middle East and North Africa region, moving to this ‘healthier lives’ model will necessitate more focus on the primary care sector. Even healthy people need to see a general practitioner once a year. It is in this way that diseases are detected earlier, diagnosis is more complete, and patients are referred at the appropriate time for subspecialist care. Our regulatory partners are working toward introducing a referral system where patients are initially seen by a general practitioner before being referred on to a specialist if necessary.
Prioritising collaboration and information exchange in patient care
The ability to collaborate effectively will be a fundamental predictor of success in improving outcomes. We must significantly improve strategic outreach, combining best practices, cutting-edge innovation, and global talent with the kind of expertise that will create a step change in the healthcare provision on a global scale.
Integrating care between medical facilities requires several key steps, including the shift to a single electronic medical record system, inter-facility consultations, and real-time patient monitoring.
All Cleveland Clinic facilities have a single, integrated medical records system, allowing care teams to gain a clear understanding of a patient’s medical history across all our international locations, whether in Abu Dhabi, Florida, or Ohio. This seamless integration lets us offer carefully tailored, personalised care, regardless of where the patient is being treated. Future challenges include developing processes to include other healthcare partners in our best-in-class medical records system, while ensuring top-level data security. This will be supported by an innovative integrated healthcare network led by Mubadala.
Patients also benefit when multidisciplinary teams meet and consult with their colleagues through video-conferencing and collaborative technology. Such collaboration allows teams of physicians to discuss complex cases, adding another layer of expert evaluation when deciding on how to proceed with treatment. This can be a welcome extra layer for a patient, providing peace of mind that his or her case has had as thorough a review as possible.
Placing research at the heart of an integrated healthcare system
Research and investigation, to build our knowledge of health issues within a population, are the foundations of good health and appropriate, effective care. By understanding the reasons behind a community’s health challenges, and devising new ways to treat those problems, we can tailor treatments to meet their specific needs.
A great deal of advanced medical research is conducted in the United States and Europe, studying western populations. This approach has led to an imbalance in the quantity and quality of population data available for certain parts of the world, including the Middle East.
Closing this gap must be a priority, and we need a coordinated, multi-agency approach to developing research programmes that consider the needs of this region. As a designated human subject research facility, Cleveland Clinic Abu Dhabi has partnered with several local institutions to conduct population health studies and support core research in the region.
The need for accurate data takes on a greater urgency during a period of transformation and change. If we are investing in technology-led solutions to address medical needs in the community, and reorganising patient-facing services, decisions on how to prioritise and apply resources must be evidence-based.
Last year, our clinician scientists published 137 peer-reviewed academic medical papers, reporting on innovative treatments administered at Cleveland Clinic Abu Dhabi along with the outcomes of those procedures. Many of our caregivers are also thought leaders in their fields and known globally for their work.
At Cleveland Clinic Abu Dhabi, we also continue to expand our educational facilities, which now include a full range of post-graduate opportunities from physician internships to residencies and fellowships. We welcomed our first cohort of physician interns in 2017, and our specialist residency training programmes will commence later in 2018.
Sustaining the foundations of care
In conclusion, as the world becomes more closely connected, and the population ever more global, healthcare provision will continue to change dramatically. The formulation of strategic priorities that highlight future investment in innovation, research and the ethical use of healthcare data, will align around the shared goal of providing world-class care to an increasing number of lives globally.
Change presents opportunities for high quality, specialised care providers to make a global impact, building the hubs that will deliver a new form of preventative, connected and community-focused care. Embracing these challenges will enable us to confidently ensure the highest global standard of healthcare is delivered in a culturally appropriate way at the local point of need.
Surgeons Perform the UAE’s First Double-Lung Transplant Surgery
Multidisciplinary teams of surgeons at Cleveland Clinic Abu Dhabi have performed three transplant surgeries from a deceased donor on the same day, including the UAE’s first double-lung transplant. The surgeries – double-lung, liver and kidney – took place on June 10, and a kidney from the same donor was transported for a transplant operation at Sheikh Khalifa Medical City.
Double-lung transplants, also known as bilateral transplants, see both lungs removed and replaced with donor organs.
Earlier in 2018, Cleveland Clinic Abu Dhabi had performed successful lung and liver transplants, following on from the country’s first full heart transplant in December 2017.
Dr Redha Souilamas, Chair of Thoracic Surgery at Cleveland Clinic Abu Dhabi, led the double-lung transplant, assisted by a multidisciplinary team of 10 specialists, including cardiothoracic surgeons, pulmonologists, anesthesiologists and critical care nurses.
The double-lung transplant patient, a 45-year-old expatriate female, had been suffering from idiopathic pulmonary fibrosis (IPF). A progressive disease that causes extensive scarring of the lungs, there is no cure for IPF and patients are typically given a three- to five-year survival rate after diagnosis without transplant surgery.
To complete the operation, the surgical team used an innovative, minimally invasive approach without the need for a cardiopulmonary bypass, making two small incisions on either side of the patient’s chest. This ensures a faster recovery time; shorter hospital stay; and little to no scarring compared with the standard approach, said Dr Souilamas, who has performed 150 double-lung transplants over the past 10 years.
Dr Antonio Pinna, Transplant Surgeon in the Digestive Diseases Institute, led the team for the liver transplant for a female patient from Ras Al Khaimah, who was suffering from severe cirrhosis. She is recovering well following the operation.
The kidney transplant operation was led by Dr Bashir Sankari, Chair of the Surgical Subspecialties Institute and head of Cleveland Clinic Abu Dhabi’s transplant programme, providing vital surgery for another patient on the hospital’s transplant list.
Cleveland Clinic Abu Dhabi’s transplant programme works with a number of key organisations for multi-organ operations, including the Cleveland Clinic Transplant Center in the US, Mubadala, Abu Dhabi Police, the Department of Health, Ministry of Health, National Transplant Committee and a number of other government entities.
“When we opened our doors in March 2015, we made a promise to bring advanced complex and critical care services to the UAE, removing the need to travel abroad for life-saving medical care. Cleveland Clinic Abu Dhabi’s latest multi-organ transplants mark another significant moment in that journey,” said Dr Rakesh Suri, CEO, Cleveland Clinic Abu Dhabi,
“It’s worth reflecting on the incredible contribution that the donor and the donor’s family have made by sharing their precious organs – four lives have been transformed by this selfless gift. We will continue to work with the relevant authorities to support the development of a nationwide transplant list and donor management network, so that more patients will be able to benefit from this life-saving opportunity,” Dr Suri concluded.
All three patients are recovering well.