Peter Makowski had helmed healthcare institutions across the U.S. for 30 years before he was brought on as CEO at American Hospital Dubai (AHD) in 2014. There he oversaw AHD’s expansion as the hospital increased its bed capacity, built new surgical and acute care centers, and opened its first satellite clinic. The 254-bed hospital made a name for itself in May 2000, when it became the first hospital in the Middle East to earn JCI-accreditation status.
What’s the genesis of American Hospital Dubai?
This year, we are celebrating our 20th anniversary. The hospital is founded and owned by a local prominent Emirati family, who saw in the late 1980s that there was a tremendous number of Emiratis going abroad for their healthcare needs. The services they needed were not available here, or for those that were, they were concerned about the quality of care. The family asked, “Why are we allowing that to happen?” So they set out to study the U.S. healthcare system, learn what they could and then did their best to replicate it in Dubai so residents didn’t have to go abroad for care. Their vision was to build the best private healthcare institution in the gulf region, operating under American standards.
How is running a hospital in Dubai different from running one in the U.S.?
Honestly, there are more similarities than dissimilarities. That’s because this hospital runs on the same health standards and practices that I’m used to seeing in the U.S. From an operational and strategic standpoint, there’s not much of a difference since we are Joint Commission and CAP certified. For example, departmental policies and procedures, bylaws and governing are mirroring what you see in the U.S.
On the other hand, culturally, the contrast is glaring. Our staff is very diverse — from all over the world. It’s a challenge to assure uniform standards of care and clinical training for all of our doctors and nurses throughout the organization. And the same is true for patients. In the U.S., you expect patients to conform to U.S. cultural norms. Dubai is very cosmopolitan — 85 percent of residents are expats. How cultures deal with the hospitalization or near death of a family member varies widely. To provide the best care possible, you have to — and want to — adjust as best you can to their cultural roots and beliefs.
How have advancements in technology impacted AHD?
We have all the state-of-the-art technology any hospital could dream of to provide our services. We don’t provide quaternary care or transplants — we understand that the volume of those cases is insufficient. But those services we do provide, we provide to the best to our ability.
Take our imaging services: two months ago, we acquired a state-of-the-art 640-slice CT machine from Toshiba. But six months ago, just after we had put in the order, senior executives came to the hospital to tell me about a new generation machine being released, with only five of its kind in the world. The new device’s throughput is much quicker, and better yet, it produces 85 percent less radiation dosage exposure. “Because we know that you are pioneers in the UAE,” they told me, “we want to give you the new generation one.”
How has AHD had to adapt to meet changing disease burdens?
Our strategic plan is driven by the needs of the population. If we want to venture into various service lines, we are going to go all in. We are taking a look at chronic diseases prevalent in the UAE, like cancer. There is a significant need for cancer services in the UAE, and we are trying to meet that need as best as we can. Our cancer services for adults and children, medical oncology and radiation therapy grew by 25 percent year over year. We are applying for center of excellence in cancer through JCI.
Diabetes affects 20 percent of the population here, and we have a very robust diabetic program for adults and children. Cardiovascular disease is also prevalent, which we treat at our cardiovascular center of excellence. We recently purchased a new electrophysiology lab for US$800,000 (3 million Dirhams), which is run by a physician from the U.S.
AHD recently started a collaboration with the Mayo Clinic. How has that impacted the hospital?
Our affiliation with the Mayo Clinic, which began in June 2016, is a real game changer in delivering tertiary level services. Currently, 3,000 patients from the UAE routinely receive care at the Mayo Clinic — but we want to keep those patients here. The hope is that we can provide the same level of care at AHD as they do at the Mayo, and this affiliation gives us access to a wide range of tools to achieve that.
Our physicians can reach out to their peers at the Mayo Clinic for difficult and challenging cases through e-consultation. They have 24/7 access to the Mayo database library. A live broadcast of the tumor boards at the Mayo Clinic, where a multidisciplinary cancer team analyzes and discusses cases, is open to our staff here. Archived video recordings of grand-round presentations are available for our clinicians to access and watch. And, of course, we have regular visits from Mayo physicians and an exchange program, which gives us a new modality for training and expertise development. This has significantly lifted the bar at our hospital, and in the UAE, in terms of quality and patient safety.
This affiliation also helps us with physician recruitment. It’s very attractive to potential candidates and a powerful retention incentive — doctors know how much they stand to lose when they leave. Mayo clinicians are even recommending us now: an American citizen was receiving cancer treatment at the Mayo, and the clinician noticed he was coming from Dubai. He told his patient, “I know the clinicians at American Hospital Dubai, and I trust them.” The patient is receiving care here now.
Dubai has a growing reputation as an mHealth innovation hub. How have the public and private sectors encouraged entrepreneurship?
Innovation and growth are at the heart of Dubai itself. I can visibly see very significant change in the last 2 1/2 years — it’s nearly unrecognizable. The UAE government has a strategic vision, called the UAE Vision 2021, and world-class healthcare is one of its highest priorities. The rigor and expectations the government has put on the healthcare sector is impressive. In Abu Dhabi and Dubai, the insurance mandate requiring all people to have health insurance is in effect. They have also mandated that all healthcare facilities be accredited.
The government also sees the value of making the UAE a medical tourism magnet, keeping medical travelers here instead of sending them abroad for their healthcare. And entrepreneurship is the key to that development. There’s a lot of room for growth, as well. Compared to the U.S., we’re not as advanced, particularly in continuum of care from non-acute to post-acute. But we are getting much more aggressive in building that continuum. That climate of innovation and growth, and the money to support it, is bringing entrepreneurs to Dubai.
Evidence shows that the government very much values public-private partnerships. Our case is a good example. They supported our affiliation with the Mayo Clinic. There are a number of Western private healthcare institutions that have a presence here: Johns Hopkins, Houston Methodist and Children’s National all manage hospitals in the UAE. There is terrific admiration for the U.S. healthcare system. And instead of reinventing the wheel, the government wants to bring the expertise of U.S. institutions to the UAE. We can expand our healthcare system more effectively and more cost-efficiently through partnerships with established institutions.
What’s next for healthcare in Dubai?
There are three areas on the radar for healthcare expansion in the UAE. First, information technology is on a huge growth curve — the government has introduced an initiative that all providers must be on some form of electronic medical record (EMR) program by 2018. Here in Dubai, we’re hopeful that by 2018 all hospitals will provide patients with a single EMR system across all hospitals, giving any provider access to patient records.
Medical education is the second major focus for investment. We need more in terms of training Emiratis in the fields of medicine, nursing and pharmacy. Currently, construction is planned for three new medical schools, five nursing programs and a pharmacy training program. And lastly, the government wants to get actively involved in medical research. But research infrastructure is so expensive and vast that to attract the brightest research projects would take years. The UAE has tackled this by forging research partnerships with leading medical institutions across the world, lending their resources and reputations to our hospitals.
— Alex Freedman
Alex Freedman is a freelance healthcare writer based in Portland, Oregon.
Update: The article originally misstated that AHD's new electrophysiology lab was used for radiation therapy. It was actually acquired for AHD's Heart Center to treat cardiac patients.