Creating Performance Indicators for Public-Private Partnerships in Healthcare-Saudi Arabia

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Johns Hopkins University
Introduction The Saudi government and Ministry of Health are under increasing pressure to find, evaluate, select, and adopt new solutions in order to improve the quality and access to healthcare facilities. One solution the government is exploring is public private partnerships (PPPs), the premise being that the private sector has more experience in effective and efficient operations and management of healthcare services. However, when adopting such solutions, the primary focus of decision-makers is the financial and managerial aspects during negotiating the contracts and partnerships with the private sector. This dissertation has made an effort to take the perspective of healthcare experts on prioritising proposed indicators in the two main domains of quality of care and access to care; for potential inclusion in contracts between the government and the private sector to manage the services utilising the PPP models. Study Aims The study began with a literature review about the Saudi healthcare system and the history of PPPs and management reforms in Saudi Arabia, aimed at understanding the historical relationship between the two sectors. The second manuscript focuses on the selection of performance indicators by experts, using the Delphi technique, to determine which should be included in the contracts between the government and the private sector for managing and operating the services in secondary care hospital settings in the Saudi healthcare system. Finally, the third paper assesses the feasibility of measuring the selected indicators if they were to be included in the contracts. However, the main objective of this study is to propose a methodology to decision makers suggesting ways to consider the healthcare professionals’ perspectives and inputs as part of contractual performance measurements with respect to important domains such as, quality of care and accessibility in initiatives such as PPPs. Methods The first manuscript’s methods included a review of literature between 1980 and 2017. The sources and type of the literature were from international and national journals in addition to local libraries to review both peer-reviewed papers, thesis and grey literature. For the second manuscript, the method used to reach an agreement among the experts to select the indicators for PPP project was Delphi technique with a questionnaire of list of indicators from valid sources, whereby the experts can rank them and score them using Likert-scale for scoring of each indicator. Finally, the third manuscript was a cross-sectional study of evaluating the feasibility to measure the recommended indicators from the second manuscript. This was achieved by sending a questionnaire with five questions to the quality directors in each hospital in the pilot. Thereafter, the discrepancy between the scores of the feasibility for each indicator was compared among the four hospitals by using Golden Standards method. Results The work from the first manuscript provided a general overview of the management reforms in the last three decades in the healthcare system in Saudi Arabia. Moreover, the study analysed the history of the relationship between the governmental and private sector in the healthcare industry during the same period. In the second and third manuscripts, the experts recommended 23 performance indicators including 17 Quality indicators (two for clinical care, 13 for patient safety, and two for patient-centred and coordinated care) and six Access indicators. Three of the 23 indicators were identified non-feasible to be measured and have high discrepancies among the pilot hospitals. It is proposed that these 20 recommended and feasible indicators can be included in contracts when the private sector is assuming control and offering services while utilising the PPP model. Conclusions In healthcare system, it is essential and significant to consider the perceptions and perspectives of healthcare professionals on monitoring and measurement of the performance, when private sector companies start operating and managing the services, historically offered by the government. Moreover, the experts appreciated the process followed in seeking their input using an evidence-based methodology such as the Delphi technique, which provides a good opportunity to achieve a general agreement among experts.