Mark O'Brien: Hello. I'm Mark O'Brien, and you're listening to Transformational Healthcare Leadership, a podcast series from Oxford University's Saïd Business School, a collection of interviews with leaders from across the globe exploring the five key themes of the school's healthcare leadership program, the personal leadership journey, understanding the evolving environment, effective strategy formation, driving innovation, and improving performance. The COVID-19 pandemic precipitated massive disruption in healthcare, so how have healthcare leaders responded to this challenge? What are they thinking? What personal journey are they on? How do they survey the changing landscape? What strategies have they tried or intend to try to ensure their team, their organization, their country not only survives, but thrives? In this episode, my colleague and the academic director of the Oxford Healthcare Leadership Program, Dr. Eleanor Murray, interviews Rana Nabulsi and particularly explores the themes of driving innovation and improving performance with a strong value creation lens, including responding to challenges of climate change. Dr. Rana Nabulsi is the head of operations in quality-pathology and genetics at the Dubai Health Authority in the United Arab Emirates. With a PhD in quality management and an executive MBA from INSEAD on her leadership hand, and a master's in genetics and a bachelor of laboratory science on her scientific hand, Eleanor began by asking Rana about her interest in eliminating waste and driving efficiency in the diagnostic sciences particularly using lean methodology. Rana Nabulsi: In fact, healthcare systems worldwide are moving towards value-based healthcare and sustainability in order to create patient-centered environment. We are responsible of improving the value of diagnostic laboratory testing by reducing waste that has caused most waste in healthcare industry and diagnostic laboratories. It's mainly in the following areas, transportation, inventory, motion, waiting, over-production, over-processing and defects. For example, we had implemented lean strategy to reduce the patient waiting time at sample collection areas or phlebotomy areas. Also, we consolidated all laboratories at primary healthcare centers to reduce duplication of services, to share analyzers, equipment and consumables and, hence, increasing efficiency, productivity and reducing cost. Currently, we are in the process of optimizing test utilization and reducing repetition of test or unnecessary tests. We are encouraging our clinicians to follow the Choosing Wisely guidelines. Previously, we were able to decrease the defects in the testing and diagnostics, coding, billing by implementing Six Sigma and continuous auditing. We are encouraging just-in-time inventory system. We don't over-order or over-purchase because we believe this is a waste. In addition to this, we studied the physical movement flaws of our medical team, our staff in the lab, and we tried our best to streamline the patient and the staff experience. We reduced the journey to personal through eliminating waste of motion by keeping supplies within reach and having the equipment located in convenient places. In general, we are focusing on all sustainability practices that's helping us in reducing waste, reducing plastics, reducing water consumption, energy consumption, and hence, again, it's a lean management. Eleanor Murray: Rana, I think this ties in very nicely into your work on addressing climate change by reducing the carbon footprint in the laboratory. If I understand correctly, laboratories are the biggest contributors to single-use plastic waste, power and water consumption, and the production of toxic chemicals in the healthcare world. What initiated your interest in driving strategy to address climate change by reducing this waste? Rana Nabulsi: In fact, globally, laboratories are using a lot of resources. In general, labs are 10 times more consumers for energy and five times more consumers for water than office spaces. Labs are throwing 5.5 million tons of plastics to the environment on yearly basis. If the labs are willing to divert just 2% of their lab plastics from the landfills, they would be saving more than 100 million metric tons of carbon dioxide. We have to agree all that our planet is at risk. We have to pay now, and the costs are up front. Global warming and climate change is a global crisis and responsibility that goes beyond national borders. Climate change and global warming is a result of not having the right sustainability practices. Accordingly, what initiated me and gave me the interest is to find the needed efforts to build leadership at the top to drive strategy, sustainability practices in healthcare system in order to save the environment. In addition to this, we are suffering day and night from natural resources scarcity, shrinkage and biodiversity, pollution and energy transition. Finally, we have to admit the fact there is ESG pressure from government, NGOs, organizations regarding sustainability and climate change. The growing noise about climate change and sustainability will make us work hard in laboratory departments worldwide to focus on reducing energy, water waste, plastics and reducing the pollution to the environment and save the planet for the future generations. Eleanor Murray: Yes. In preparing for this interview, you spoke of your passion for improving the financial health of healthcare and the dynamic of reducing costs while still improving outcomes. Can I ask you to speak about your drive to spread values-based healthcare? Rana Nabulsi: In fact, the concept of implementing value-based care is to provide highest practices for patient outcome and reducing cost simply because, if we are financially sustainable, we can sustain providing the services to our patients everywhere. As you know, nowadays, the incidents of chronic diseases are increasing day and night, and the rise of innovative technologies are increasing day and night. It's very important and very critical for governments and private sector to work hard on linking the patient outcome with the payment as well, so pay-for-performance has to be an encouragement for healthcare providers, payers and patients who are paying out-of-pocket spenders, that they have to link the outcome with the cost. The advantage of value-based healthcare is that the payers and the patient shall pay less money to achieve better healthcare outcome. At the same time, we are encouraging providers to achieve efficiencies, productivities and a greater patient satisfaction. Other stakeholders like suppliers, other industries, regulators, insurance shall outline their practices as well to improve patient outcome, reducing cost so we save societies, our societies and communities becomes healthier while reducing overall healthcare spending. As a summary, value-based healthcare will encourage reduced healthcare spending. At the same time, it's for better overall health. Eleanor Murray: I'm interested in that in terms of how you start to influence people around that to see the benefits of value-based healthcare. Rana Nabulsi: The fact that many insurance companies are becoming very strict when it's covering elderly with chronic diseases, with preexisting conditions, people are spending from the pocket money and insurance is not willing to cover genetic testing, for example, and high complexity testing, the fact there's a big pressure from governments and societies to utilize the innovative technologies, AI, data science and other machine learning, new technologies to be introduced to the healthcare system, whether in treatment, whether in diagnosis, accordingly, patients are at critical situation where they need to save money. At the same time, they don't want to spend too much because of inflation, because of too many challenges worldwide. At the same time, they need the best healthcare system built on AI, built on data science, built on innovative technologies, telemedicine, online consulting. That's why we have a big passion towards value-based healthcare. Remember, it's like patient outcome above cost, but it's not just financial cost, it's environmental cost and social cost, so the concept of sustainability here in full alignment with value-based healthcare and full alignment with pay-for-performance. Eleanor Murray: Thank you. You're also a strong advocate for international benchmarking of healthcare costs and outcomes. Can you talk about how you develop that interest, and then how you advocate for and utilize that benchmarking in Dubai? Rana Nabulsi: Benchmarking is an art of measuring your processes, your patient outcome by comparing your industry with other healthcare organization in the same industry. We need to search for best-in-class performance. Just focusing on KPIs on yourself will not improve you. Comparing your figures such as average length of stay, cost of a procedure, infection rate is not enough. It will lead you to wrong conclusion and decisions. Just looking on the figures and what people are doing in other organization or state-of-the-art healthcare organization will teach us how to get their best practices and how to leapfrog our patient outcome in a minimal time and achieve clinical excellence with cost-effectiveness. As we know, our society is struggling with the challenges of cost containment in addition to the fact that chronic diseases, elderly, aging, neurodegenerative disorders, all these are chronic and heavy burden on societies, on governments. Accordingly, we need the best outcome for our patient with the least cost. That's why I need to compare myself with other organization, best-in-the market when it comes to clinical practices and clinical outcome, because the patient deserves to implement best-practices for him and he deserves to have the best services, maximized client satisfaction and improved patient outcome. As a summary, we need to utilize benchmarking to identify our strength and areas of improvement and facilitate the development plans and identify our gaps in order to monitor the progress and our achievements. Eleanor Murray: Thank you. How open are others to adopting those same benchmarking practices that you're describing because, as you say, it's best in class, but some of the challenges in healthcare are maybe that data is not always available or people maybe don't want to adopt those benchmarking practices? Rana Nabulsi: In fact, we are facing, currently, sustainability metrics. When it comes to patient outcome, clinical practice outcome, clinical pathways, it's there in the literature available. We have an issue when it comes to sustainability practices. We cannot benchmark our sustainability practices with other healthcare organization simply because this is new, and understanding, still, many healthcare organization is not digesting the fact of how to implement sustainability inside their organization. Accordingly, we cannot find benchmarking. We don't have goals. We don't have targets. The best scenario is to keep comparing yourself with the previous year, keep improving on the percentage of improving and then, till you find many organization, healthcare organization, start the research, start publishing their achievements and success stories and they're measuring their success here, we can start the benchmarking. It will take time. As you said, it needs data. It needs global efforts and collaboration to put everything on the table, and people will start comparing themselves with the best practices in the market. Eleanor Murray: Yes. Are there industry sectors that we can look to, that health can look to as examples of best practice in this? Rana Nabulsi: In fact, we have some common best practices when it comes to water waste, electricity consumption, environmental hazardous we can share with industrial areas. They have hazardous and toxic material. Healthcare organization have also hazardous and toxic materials polluting the environment, so definitely we have an overlap, and we can compare our industry. We have some benchmark when it comes to gas, green gas emission intensity and turning these practices into carbon footprint, but some practices in healthcare organization like surgeries, for example, anesthetic drugs and gases, we cannot compare these areas with other industry. It's just inside the healthcare organization. We need to create a benchmarking between our healthcare organization and best-in-practices for these practices. Eleanor Murray: Thank you. I know that you have another deep interest, which is in genomics. Can you tell us about how the Emirates is looking to use genomics to improve the healthcare and wellbeing of the population? Rana Nabulsi: Well, recently, the Emirati Genome Program, an initiative focused on providing preventative and personalized healthcare for citizens of United Arab Emirates, experts in genetics, experts in data science, experts in AI, experts in genetic counselings are going to recognize the genomic technology. That could be a key in improving the healthcare of UAE nationals. The Emirati Genome Program is also a part of the country attempts to strengthen its position as a hub of innovation, research and genomics in the area. We have the Omics Centre of Excellence. We have joint ventures already between technology, genetic testing, Omics facility, data science experts in order to make this a great success. We need to remember that genomics nowadays is transforming the healthcare by providing us far more detailed understanding of diseases' progression, prediction of diseases. The Emirati Genome Program's role is to enable the healthcare and medical community to harness the power of genomic technology science to improve the health of local population and deliver the key healthcare priorities and resources for UAE government. As we all know, the societal cost of healthcare is rising day and night, and the longevity is a requirement for most countries. Most countries are benchmarking themselves by the longevity KPI. We'd love our people to live longer. To provide a prevalence of long-term complex disease prevention, we must take advantage of the current developments in genomics to increase the prevention and early diagnosis of these diseases. Clinical team, scientific team, industry innovations, all of them, they scale their expertise with this trusted technology to deliver the best outcome for UAE national and deliver the best possible care to all our patients. Eleanor Murray: Thank you. One of the things that strikes me as you're talking about all these different areas that you have an interest in is that they're all working at a systems level rather than just an organizational level. Rana Nabulsi: Yes. There's a big collaboration in Dubai and Abu Dhabi as well between academic institutions, between clinical settings, genetic testings, Omics, AI, cloud-based companies, all of them systemized, integrated to support the project of UAE Genome. Eleanor Murray: Do you think this is the way that healthcare needs to think in the future is to achieve systems change rather than just change within organizations? Rana Nabulsi: Yeah, definitely. Such type of a study actually needs integrated efforts, need multidisciplinary teams, need experts from the industry, from the technology, from the clinical side, from the data science side, AI. You cannot find all of them under one roof, so, definitely, you need the collaboration between all these stakeholders to make the best outcome of Emirati Genome Program. Eleanor Murray: Thank you. Finally, we ask all contributors to this podcast series the same two questions at the end of each interview, so the first is what possibility in the healthcare ecosystem excites you as you gaze into your crystal ball the next 10 years? Rana Nabulsi: Actually, what makes me excited more is the need to improve patient care and patient outcome through digital health technologies and innovation such as telemedicine, remote monitoring, wearable devices, AI, startups, medical tech and other innovative technologies that can really support our patients and improve efficiency at the same time. In addition to this, we need to leverage the AI machine learning digital technology to facilitate a clinical decision support system such as a clinical algorithm, CDS system. We need to support our clinicians with the right diagnosis for the right time and with the right tools to improve the patient outcome. Moreover, we need to explore the use of data analytics to improve the patient experience, patient outcome and increase the efficiency of our procedures, our expertise, our clinical decision support system. Eleanor Murray: Thank you. Those two areas, tech and data analytics, seem to be really fundamental in how healthcare can improve and be successful in the future. As a leader yourself, what's the one piece of advice you would give your 20-years-younger-self about becoming a powerful leader? Rana Nabulsi: My sincere advice to future leaders is to focus on the leadership traits and characteristics and skills from the fact that they have to be able to develop teams, being visionary, master the style of execution, be able to make decisions and having well-cultivated self-awareness, from emotional intelligence, to good listening skills, to mentoring, to energizing and influencing staff. Why? Simply because leaders, and future leaders, they have many challenges from developing technology, innovative AI solutions, from the government mandates that keep changing day and night, insurance policies, reimbursement. The rising cost of many medical treatments, medical equipments, prescriptions are the most challenges leaders are facing in leading hospitals and centers and all levels of healthcare organization in addition to the fact there's big demand on increasing focus on data. At the same time, they ask leaders to focus on transparency and confidentiality and security. We have many challenges leaders are facing currently. In the future, we'll be even facing more because we have issues with the staffing concerns. We are losing talents. We are having some specialties that's not becoming attractive anymore and we have sometimes burnout of some of our staff. All these challenges really needs a good skills, knowledge, experience, maybe certification, maybe training, maybe credentials in business, finance, healthcare administration, strategy, policy and then know about the insurance, know about the finance, know about the industry, how to negotiate with suppliers, how to speak the language, because healthcare is really siloed between hospitals, regulators, insurance industry, stakeholders like vendors, suppliers, regulators. At the same time, some leaders, they don't have the language to link between both, and they don't have the same skill sets of linking and aligning the sustainability of the organizational from financial side and the clinical side. In summary, in order to ensure the wellbeing of healthcare system, it's very essential to sustain the organization with a good leadership staff, that they can build their knowledge and expertise in management, finance, business, policy, strategy and bridge the gap between departments, clinical team, develop talent and, the most important, optimize the system for the best patient outcome. Eleanor Murray: Thank you very much. I think that's wonderful advice. I think it really emphasizes that technical skills alone are not enough to move the health system forward, that all these broader leadership skills are what are needed to really make that fundamental change. Rana Nabulsi: Yeah, I agree with you, Eleanor. Currently, we can see many clinical team are moving for other credentials and certification in sustainability, in business and finance, in policies and insurance, HR, other industry that really are very critical for healthcare system to sustain, maximize patient outcome and meeting the society demand when it comes to the best innovative technology, the telemedicine, wearable devices, AI infrastructure, data security, genomics and other challenges we are requested to introduce inside our healthcare organization. Eleanor Murray: Yes. I think there are some real nuggets in there that's very important, particularly this idea of being able to share the same language. I think one of the challenges in healthcare is that, as you say, it can be very siloed, and each silo has its own terminology and language that others don't necessarily understand. Rana Nabulsi: I agree, Eleanor. In addition to this, as we started, we are saying financial wellbeing of healthcare organization will ensure the sustainability. Clinical team, nursing support services, they have nothing to do with the finance and the costing and the CapEx and OpEx, and they will not negotiate with the suppliers. They will not look into balance sheet, for example, Excel Sheets. They don't talk the strategy language or the policy language and the business, what's happening in the market. We need leaders to fill the gaps between departments, engage teams, develop talent, at the same time, optimize system efficiencies within the healthcare context. Eleanor Murray: Yes. Yeah, I think that's very true. Dr. Rana Nabulsi, it's been wonderful listening to your passion and your expertise today. Thanks so much for giving us generously your time. Thanks very much for listening to this episode in our podcast series. If you enjoyed this podcast, please subscribe to hear future episodes and tell your friends. For those interested in furthering their healthcare leadership journey, by joining us at Oxford, the executive education offering that Mark and I have the privilege of leading at the Saïd Business School, please search for the Oxford Healthcare Leadership Program website where you can find dates and enrollment details. We'd love to see you at Oxford. Thanks for joining us today. Rana Nabulsi: Thank you, Eleanor. Mark O'Brien: You have been listening to Transformational Healthcare Leadership, a podcast from Oxford University's Saïd Business School where we speak to outstanding healthcare leaders from across the globe who share their insights on healthcare leadership as we navigate the complexity of modern healthcare delivery. For those interested in furthering their healthcare leadership journey, by joining us at Oxford for the executive education offering that I and my colleague Eleanor Murray have the privilege of leading at Saïd Business School, you can find details about the Oxford Healthcare Leadership Program in our show notes. We'd love to see you at Oxford. Transformational Healthcare Leadership is produced by Chris Ashmore Media. If you enjoyed listening, please subscribe to hear further episodes and tell your friends. Thanks for listening.