Health Service Focus


What reliability means to healthcare

Source: NHE Jan/Feb 18


H.E. Dr Bandar Abdulmohsen Al Knawy, president of King Saud bin Abdulaziz University for Health Sciences and chief executive of the Ministry of National Guard Health Affairs (NGHA), talks to NHE’s Luana Salles about how his new book can help make the NHS an even more reliable system for patients.

The more we think about the NHS as a national health service tailored to the needs of UK residents, the more likely we are to forget that healthcare is, in fact, a universal concept. There is much more that connects systems around the world than what sets them apart, regardless of regional particularities.

That is exactly what H.E. Dr Bandar Abdulmohsen Al Knawy – president of King Saud bin Abdulaziz University for Health Sciences and chief executive of NGHA – tried to reflect in his new book, ‘Leading Reliable Healthcare.’ And that sentiment is best encapsulated by the book’s key differential element, which sets it apart from any other literature in the sector: the work contains contributions from high-profile and recognised healthcare leaders from around the world, not least including the UK.

“When we talk about health, it doesn’t matter where it is. Globally, people will see the same issues,” he explained. “I actually remember a quote from one of my old professors from when I was in medical school: he said that the patient never reads the textbook. Which is true; patients never do. Health comes in different presentations, in different activities, but in the end it’s all the same. Therefore, I tried to choose from different parts of the world to be sure that we can link everyone.”

From a UK perspective, Dr Knawy carefully handpicked some renowned figures: Richard Hobbs, director of the NIHR School for Primary Care Research and head of the Nuffield Department of Primary Care Health Sciences at the University of Oxford (who wrote the chapter on primary care and hospital integration); Jules Martin, managing director of Central London CCG (author of the chapter on performance parameters); Dr Bruno Holthof, chief executive of Oxford University Hospitals NHS FT (who wrote the section on quality vs. cost); and Tara Donnelly, CEO of the Health Innovation Network in South London (who led on innovation).

But there is no shortage of talent from elsewhere, and right from the very first page, which already opens with a foreword from John Hopkins Medicine CEO Paul Rothman. “While this book charts some promising routes on the path to high reliability in healthcare, most of us still have a considerable distance to travel as we implement change initiatives,” he writes. “It is up to all of us to apply these ideas at home – and to share, far and wide, the lessons learned along the way – to arrive at a place where excellence is assured for each and every patient.”

It is exactly this excellence – the desire to ensure care is being delivered in the right way, at the right time – that fuelled Dr Knawy’s ambition to write the book. These values are at the core of the concept of reliable healthcare, which appropriately forms part of the book’s title: a reliability related not to healthcare staff, but to patients, who can be safe in the knowledge that they are receiving the best possible care.

“Ensuring that we have reliable healthcare that meets patient expectations is a must,” Dr Knawy told me. “They’re relying on it not only from an availability perspective, but the confidence in receiving the best standards of care that of course meet with their expectations and lead to satisfaction. Satisfaction not in customer service, but satisfaction in their wellbeing. I think the word ‘reliable’ is very strong, and it’s essential for people to understand that when we talk about high reliability it’s not just quality and safety – it’s everything in the whole system.”

Organisational safety culture

The book is appropriately split into what Dr Knawy considers to be the top 13 priorities when looking at a whole healthcare journey.

It kicks off, for example, with a look at organisational safety culture, written by Sallie J. Weaver of the Armstrong Institute for Patient Safety and John Hopkins University School of Medicine. For Dr Knawy, organisational culture is “in everything we do.”

“When you enter a healthcare system, you can know how good it is from the beginning. If a patient walks in and sees people attend to everything in the system, from the science, to the friendly facility and the cleanliness, for example, they will be confident and comfortable to say ‘well, I will hopefully be getting a good care or clinical outcome in here’ if the organisational culture is good,” he explained.

“That’s very important, and we chose it specifically to be the first chapter to make sure it is there to help the patients.”

According to him, it is the job of leaders to ensure a positive organisational culture is in place; and according to the chapter’s author, healthcare leaders currently have “a lot to learn” from other sectors – such as oil and gas, nuclear power, aviation and military – who achieve outstanding levels of safety and performance despite operating in high-risk environments.

“These organisations have mastered the ability to anticipate the unexpected, adapt, and produce reliably safe, high-quality outcomes despite the significant complexity and inherent risk in their work,” wrote Weaver.

leading book  copy edit

Information Technology (IT)

Despite its position as the sixth chapter, another fundamental aspect of reliable health lies in digitisation. “Health IT functions like the central nervous system of healthcare,” Dr Knawy explained. “We need a good electronic patient record (EPR) system which is able to measure your performance, that is secure, that is protected for patient confidentiality, and that covers the whole of the patient journey. The value of electronic medical records is unmatched, actually; it gives you everything, because it tracks patients’ journeys, particularly in emergency situations or for those who are in critical conditions.

“Stability of the EPR system is also very important, because it doesn’t just track patient care, but everything throughout the system: the supplies and the equipment, for example.”

According to him, investment in healthcare technology, which also forms part of this digital ambition, is a guaranteed cash-saver, not least because it removes the need for people to be so engaged at every part of the system: the patient can book themselves in, order their medication online and take a greater lead on their own care.

Digital health and innovation

And luckily for us – despite what it might seem like from the inside, where trusts face the strenuous challenge of balancing innovation and investment in technology with day-to-day efficiency – the NHS is a major player in the field of digital. Dr Knawy specifically highlighted the annual Digital Health Conference in London as a shining example of this.

“The NHS has, for the last few years, made a major stride into digital health. [The yearly conference] has made people around the world focus on this and really brought attention to the issue. It is highly attended, and many of the people I know that attended it have learned and come back to the healthcare system to look and bring the science – and that’s very important, because unless we bring the science to the people who are middle-managing healthcare, they will not do it.

“The NHS has pioneered many innovative practices in digital health. As an example, in 2015 it launched the NHS Innovation Accelerator to take a number of proven innovations in digital health and work with the health service to scale them.”

In fact, in the chapter on healthcare innovation and reform, written by Donnelly of the Health Innovation Network, Professor Tony Young stated: “The NHS is the single largest unified healthcare system in the history of the human race. This gives us some opportunities that no one else has had the chance to do – and one of them is to innovate at scale.”

One only has to look at the book’s table of contents to understand how comprehensive it is: there is no shortage of detail, from clinical practice and patient safety to staff education, value for money and crisis leadership.

And it was written especially with NHE readers in mind: those at the frontline of healthcare management and delivery, who not only work with patients directly but who manage teams, are studying for their MBAs in management, or are the decision-makers leading new and innovative health systems. Released in late December last year, ‘Leading Reliable Healthcare’ is truly not one to be missed.


Leading Reliable Healthcare is now on sale across the UK. For more information, visit:


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