Introduction
Al Buraimi hospital was developed in 1994 to be a “Regional referral Hospital” to provide health services to people of the Buraimi governorate. The Bruaimi has a population of about 100,176. It has 150 beds. It offers a variety of out-patient as well as in-patient medical services. The hospital is one of the biggest hospitals in the Buraimi governorate. It also includes 600 administrative and medical staff or employees that involved in the direct care of patients. Al Buraimi provides a variety of services that include ophthalmology, infection, Oral care, pharmacy, dialysis and other important services. It is important for the people of Oman to enjoy quality healthcare services as a population and an individual. Hospitals are always considered as the main aspect of health in any region around the world. Similarly, al buraimi hospital is one of the important healthcare service Unit in the Buraimi governorate, and they need to have well-trained nurses and other medical professionals to provide effective and quality care.
In early years of this hospital, most of the employees were particularly foreigners that include nurses and doctors from India, Pakistan and other western countries. The educational system in Oman at that time was not effective, and some medical professionals such as nurses and doctors are not enough to fulfil the increasing demand for health. It played an important role in the provision of quality care services to people of Oman. The health ministry of Oman called medical professionals from other countries by providing good wages and quality working environment to them.
Recently, the ministry of health of Oman has given the idea to hire more medical professionals from Oman rather than from other countries. The vision of the ministry of health is to replace medical professionals from other countries to Omanis can affect the quality of care in hospitals. According to the report shown by the News 2017 has stated that “About 80 senior expatriate doctors will be replaced by qualified Omani doctors in 2017 and more to be replaced in upcoming months and years. According to the ministry of health, all these doctors have passed the necessary exams. “Moreover, least 120 local dentists are awaiting Ministry of Health’s placement and an equal number of specialists in other streams.”
The reason for such change in policy is to deal with unemployment faced by many new graduate doctors and nurses. Secondly, a large amount of money was paid to these professionals which increased the overall cost of healthcare services in Oman. Thirdly, they want to train their local professionals to increase their knowledge and competency to deal with demands in future.
The paper aims to determine the effects of replacing Omani instead of expecting workers in the medical field in Buraimi hospital. Effects that are discussed in this paper are related to the quality of care and services in the hospital as well as management and operational issues that can be raised in the absence of trained and experienced managers and administrators. Cause and effects will be analysed by using fish-borne diagram and by measuring key performance indicators. In the end, recommendations will be provided to deal with all issues and to improve quality of care and services in Al Buraimi hospital.
Statement of Problem
Nowadays, one of the most important problems faced by the health sector in the hospital of Oman is the lack of trained medical professionals. That’s why the health sector relied mostly on the medical staff from other nations. It is one of the hindrance factors that create resistant in achieving the vision of ministry of health to replace or hire the Omani employees and medical professional rather than employees from other nations.
Analysis
The vision of the Ministry of Health in the Sultanate of Oman shows that he wants to achieve its goal of rehabilitating Omani competencies in the health sector in Oman and replacing them with foreigners staffs who are work in the public health sector in different hospitals throughout Oman. The replacement of foreign medical staffs with Omanis may affect the quality of health services due to lack of experience and skills, which could lead to the deterioration of medical services at Al Buraimi Hospital. The problem of will affect the hospital operation management in some areas.
According to the Rowe et al., (2005), there are many concerned about replacing experienced expatriate nurses to poorly trained inexperienced nurses. Concerns are related to the level of experience that new graduates are coming in. Moreover, administrators who controlled the whole setup of Al Buraimi hospital are replaced with completely fresh graduates will impact the whole process of administration in the hospital. It is not easy for fresh graduates to manage the whole setup of hospitals, a little mishandling and miscommunication will affect the population of Buraimi governorate that are dependent on this hospital for their treatment.
According to the Duncan et al., (2016) the quality of health care services depends on the technical skills and practitioners knowledge. If healthcare professionals are competent enough to deliver high-quality care, then they will benefit patient and can promote healthy outcomes. It is believed that skills, knowledge and attitude come with the experience and in the medical profession, it is always important to have experience. Therefore, a large number of researchers and experts emphasised that relying on inexperienced nurses and doctors can deteriorate the quality of care. Since the beginning of Al Buraimi hospital, most of the demands of nurses, doctors, pharmacists, dentists and administrators are fulfilled by workers from other countries, which help Al Buraimi hospital to meet the demands of people of Oman and provide them excellent quality of care. Now, the introduction of inexperienced Omani nurses and doctors will somehow impact the quality of care.
Some matters are not easy to control in the real work setting. Al Buraimi hospital is one of the largest hospitals of the Oman Sultanate. The introduction of less experienced or inexperienced workers in this hospital will create a negative impact on the management of this hospital. Al Buraini hospital is the internationally recognized hospital, where all care is given under the standard policies and protocols. Therefore, since its beginning, it has been maintaining quality along with the competency. Understanding of policies and protocols require time. Therefore newly appointed managers and administrators will be unable to take charge immediately that will affect the operational processes.
According to the Singer, et al., (2013) Management and quality of leadership affect motivation and satisfaction of medical health professionals. Most nurses and doctors cannot work in a stressful environment. An experienced and well-trained manager can decrease the job stress by creating an effective environment where cooperation and learning are encouraged. In the absence of effective leadership and managers, the issues will be created regarding the environment. West, (2011) supported the fact that most nurses leave the job due to stressful environment of hospitals and they do not find any support there in the form of managers and leaders. Therefore, operational issues will be raised due to mismanagement of medical professionals and that impact on the quality of care in Al Buraimi hospital.
Research conducted by the Al-Mandhari in 2013 to measure the quality of care in 3 hospitals in Oman that included Al buraimi hospital was well. Most of the participants in that survey selected either good or very good in response to the overall quality of care in these hospitals. They also commented that western nurses and doctors were a doctor. They further elaborated that they receive better treatment and satisfy with the services provided by these healthcare professionals in different hospitals of Oman. A report generated by the News, On the response of the change announced by the ministry of health of Oman stated that however, removal of experienced and skilled individuals from certain specific positions in different hospitals of Oman particularly the al buraimi hospital will affect its capability to deliver quality care that they provide to residents from last 10 to 15 years.
It is important to discuss the quality of nurses, doctors, pharmacists, dentists and other individuals related to the medical profession that comes from other countries. Oman and other Gulf countries have highly standard criteria to work in their hospitals. Similarly, al buraimi hospitals only preferred those nurses and doctors with a heavy amount of experience in their own country and had to clear a test to get a job there. A test is based on international standards which check the skills, competency and experience of the person. It means that all professionals hired by the al Buraimi hospital are experienced in their respective fields. Therefore, it is always difficult to replace these people with young and fresh graduates. The quality of care that has been maintained from last several years has been somehow getting affected. Al Buraimi is a well-reputed hospital of Buraimi and one of the hospitals in the Oman where the provision of care is based on international standards. However, the step taken by the ministry of health of Oman may have positive impacts in future in several aspects of their economy and social life, but in the absence of experienced professionals, the hospital may face some chaos regarding the quality of care (Rowe et al., 2005).
Fish Bone Diagram
- Staff
- Operational issues
- Poor Management
- Poor quality of care in Al buraini Hospital.
- Poor Medical care
- Poor standard care and practices
Key Performance Indicators
Key performance measurement tools are considered important to evaluate the improvement of quality. It offers a way to measure what hospitals are doing and help administrators and managers to identify the room for improvement. These indicators also help to understand how reliable and effective a specific hospital in providing quality care and important services to the people. Indicators that are used in the above Al Buraimi hospital include “patient safety indicator set”, “surveys of hospital experiences of patients”, “Hospital outcome of care indicator set” and another set of indicators.
Most common indicator to assess the quality of care in hospital is the rate of Nosocomial infections. Nosocomial infections are defined as infections that are occurred in the hospital setting such as urinary tract infection, pneumonia and other common infections. According to the Mant, (2011), skilful and experienced nurses and doctors always use precautionary measures to prevent the spread of infection such as using of gloves, wash hands before and after performing any procedure. He further stated that they know about its consequences on patient’s health and the reputation of the hospital. Increased rate of nosocomial infections means that poor quality of care is delivered to that hospital and vice versa. It is believed that young nurses are very anxious during their work, due to which they forget to do basic things during the care of patients. It will increase the risk of nosocomial infection which reduces the quality of care.
Secondly, patient satisfaction with the services is another measure to determine the quality of care in the hospital. Patient satisfaction is based on a number of factors that included provider competence, proper information provided, patient-centeredness, access to quality care, outcomes and other factors. These factors are usually measured through the survey, observations and other tools. During the training of nurses and doctors, it is always emphasised on them to promote patient-centered care in practice setting while providing care to patients. According to the research conducted by the Giuffrida, et al., (2009) stated that more experienced professionals are conscious about the progress of patients. Therefore they emphasized on the approach of patient-centered care rather than work-centered approach. On the other hand, fresh graduates or inexperienced medical professionals will focus towards a work-centered approach which somehow affects the provision of quality of care.
Other indicators include the length of stay in the hospital. The length of stay in hospital is directly proportional to the quality of care in hospital irrespective of the procedure performed. Length of stay is also affiliated with the complications. If the patient receives quality care, then the rate of complication will be reduced. Morbidity and mortality are used to measure the quality of care and services in the hospitals. Increased mortality is associated with poor quality of services.
Recommendations
According to the media reports, the objective of the recent change announced by the ministry of health of Oman is to increase the job opportunities for local doctors and nurses, to increase local nurses and doctors because they are aware of local culture and language. Besides this, hiring medical professionals from other countries increased overall healthcare costs. Lastly, the step was taken to increase women empowerment as these professions will attract more women. However, the quality of care and services will be compromised by replacing experienced nurses from inexperienced and fresh graduated local nurses. It is important for the ministry of health and management of Al Buraimi hospital to take some serious steps to reduce the quality of service in Al Buraimi hospital as well as in other hospitals of Oman.
The focus should be given to training young medical professionals to provide standard and quality care to patients. It is important for health sector of Oman. Some recommendations that help to find some ways that help to achieve the vision of the Ministry of Health through the process of Organization of medical jobs and impact on the operations of the hospital and the quality of health services provided included the training of medical professionals, change the management style towards creating more supportive environment, using the experience of local experienced medical professionals, implement international standards and promote practices that reflect these international policies and protocols. Lastly, the focus should also be made on the formation of policies that promote quality care in hospitals and train health professionals to use these policies in their practices.
Firstly, the training of young medical professionals and management employees and staff is very important. Ongoing training will help them to develop their skills and knowledge to provide quality services in their respective field. Moreover, it is also important to develop feedback mechanism that can help medical professionals to identify their strengths and weakness. It will also help them to overcome their weaknesses to increase their competency and confidence to provide quality care in hospitals.
Moreover, the role of management is always important in this situation when the delivery of healthcare depends on new employees and staff. The management should adopt a leadership style that promotes encouragement and support among employees. For this, they have to create a supportive environment where employees find easy to work and cooperation with the management that makes it easy for them to share their concern with the management regarding the policies and quality of care. According to the Meehan et al., (2007) Quality of care can be increased by several means but the most important methods the training of health professionals and development of the excellent working environment.
Besides this, policies need to be created that are based on international health standards. These policies can play a significant role in promoting effective practices that will increase the quality of care at Al Buraimi hospital. Nowadays, health is considered as an important aspect of the individual life as well as the development of a society and state. That’s why a large number of hospitals including both private as well as public hospitals try to implement standard practices. These policies can improve the overall quality of care in these hospitals.
Lastly, the hiring of trained and experienced local staff can somehow reduce the poor quality services in Al Buraimi hospitals. If local trained and experienced staff are less in number as compared to demand in a healthcare setting, then it will not be a bad idea to hire some medical professionals from other countries, until local nurses, doctors and other health professionals become capable enough to provide quality health services to people.
Conclusion
The decision of replacing medical professionals from other countries with a local medical professional by the ministry of health of Oman will create several negative impacts on the quality of health in hospitals. In this paper, we have particularly focused on the Al Buraimi hospital which is one of the largest hospitals in Oman. A large number of people of Buraimi governorate depend on this hospital for receiving health care services. The reason for such change in policy is to deal with unemployment faced by many new graduate doctors and nurses. Moreover, a large amount of money was paid to these professionals which increased the overall cost of healthcare services in Oman.
Some matters are not easy to control in the real work setting. Al Buraimi hospital is one of the largest hospitals of the Oman Sultanate. The introduction of less experienced or inexperienced workers in this hospital will create a negative impact on the management of this hospital. Al Buraini hospital is the internationally recognised hospital, where all care is given under the standard policies and protocols. It is important to take several steps to deal
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