Sustainability of Medical Equipment Management in the UAE Thesis

Literature Review

The focus of this literature review is to construct an integrating framework to classify and identify relevant developments and studies on the sustainability of medical equipment management within the UAE. The literature review seeks to identify potential contributions through systematic integration of keywords related to the topic of sustainability of medical equipment management in UAE.

Google Scholar was used to examining broad literature and past projects or studies to avoid a restrictive approach to understanding the existing knowledge on the topic [1]. The literature review commenced with categorizing research on sustainable medical equipment management as implicit or explicit about comprehending their impact on sustainability within the UAE healthcare system. The term explicit was used to refer to the long-term perspective of healthcare systems management within the interdependent aspects of ecological, social, and economic development. On the other hand, the terms implicit focused on short terms suitability approaches that are focused on specific subsectors or regions within UAE [11].

The literature review activities were then differentiated on the basis of scope, that is, at national and regional levels of healthcare management systems [5]. The review then selected approaches used to target medical equipment management for sustainability indices for other countries, which were then related to the current sustainable healthcare practices in UAE. This approach is adequate for comprehensive guided literature research to avoid veering off the topic of the study [8]. The exemplary focus of this review suggests a series of approaches used in the expanding field of medical equipment management research [3].

Healthcare in the UAE

The research integrated scientific evidence to establish the current position of the topic within the expansive UAE healthcare sector. Healthcare in the UAE is run through a public-private partnership. However, the stake has taken the capital share in healthcare sector management [5]. Through different authorities, there are divisions within the UAE that manage various aspects of healthcare provision.

These authorities are mandated with the duty of ensuring optimal and sustainable practices in healthcare provision at local, regional, and state levels. The development of the healthcare sector in the UAE has experienced a paradigm shift in the last three decades as the country embrace technology, modern medical practices, and the need for a nationalize and effective healthcare provision model. At present, the UAE has one of the most effective healthcare systems in the Middle East [11].

Challenges in Project Implementation

Healthcare sustainability systems are activities focused on promotion, restoration, and maintenance of health in a country or region [4]. Health is defined as a state of complete mental, physical, and social well-being of a person or population [5]. Basically, healthcare systems are often associated with complex dynamics that must accommodate the interests of all stakeholders. These systems integrate the practice of healthcare providers as an open system with interdependency dynamics alongside environmental and social factors [8]. This means that there is no single definition for a sustainable healthcare system since it integrates several factors that are dependent on each other. For instance, many economic bulletins refer to a healthcare system as sustainable when it has stable long-term financial stability [6], [9], [15].

However, in reality, financial stability is just one of the factors defining a sustainable healthcare system. Therefore, a complete definition of a sustainable healthcare system involves balancing the economic factors, needs of patients, and actual or potential environmental costs [18]. However, this definition ignores the contribution of the healthcare personnel. In order to bridge this gap, a three-pillar model has been created to elevate the scope of a sustainable and effective healthcare system by including the concerns of the healthcare workforce [11].

Therefore, medical equipment management sustainability is a “complex system of interacting approaches to the restoration, management, and optimization of human health that has an ecological base, that is environmentally, economically and socially viable indefinitely, that functions harmoniously both with the human body and the non-human environment and which does not result in unfair or disproportionate impacts on any significant contributory element of the healthcare system” [1] (p. 152). In relation to the sustainability of medical equipment management in UAE, the current challenges could be categorized into social, economic, and environmental concerns.

Sustainability and Healthcare Management

Over the last decade, sustainability science has developed a series of approaches used to examine the three pillars of a sustainable healthcare system. For instance, theoretical orientations such as intergenerational justice, social cohesion, and quality of life attempt to associate a sustainable healthcare system with meeting the healthcare needs of a population as a prerequisite for optimal outcomes [14].

Moreover, these approaches illustrate how adaption and response to social, economic, and cultural demands would improve the existing and future sustainability systems in healthcare provision [4]. Despite the variances in the definition of a sustainable healthcare system, it is apparent that all the approaches agree on the need for a comprehensive balance between the short and long-terms focus in balancing the ecological, social, and economic interests in healthcare provision.

With regards to reviewing the UAE sustainability healthcare systems, this section of the literature review is focused on examining the application of a system-specific, and cross-regional comparison approaches in order to understand the position of this topic in UAE and other international practices [10]. Al-Neyadi, Abdallah, and Malik [2] integrated the systematic system thinking to review the sustainability of healthcare systems in the UAE.

The authors identified six categories of the sustainable healthcare system to include financial, resource, provider, quality, patient, and environmental concerns. The aspects of quality and patient represent the social pillar, while resource and financial connotes the economic aspect. This means that the ecological pillar is presented by environmental concerns [5]. This system’s causal thinking model highlights the costs associated with addressing the three pillars, thus, indicating the magnitude of interdependency among these factors.

This model was further validated by Khan, Ajmal, Hussain, and Helo [11] through a qualitative assessment of the causal relationship in different hospitals in the UAE. Another study by Kelly and Smith [17] validated this model by examining eleven criteria that are significant for a healthcare system to be declared sustainable. As captured in table 1, the system-specific approach defines the scope of interdisciplinary networking and continuous strategic research to present relevant goals [15].

Table 1: Criteria for medical equipment management system sustainability.

Medical Equipment Management Lifecycle

Process

Several approaches have been used across the UAE to develop systems that manage and regulate the medical equipment management lifecycle. For instance, the UAE Sustainable Development Strategy is a successful policy framework that has practical indicators for sustaining medical equipment management. Developed in 2007, this policy framework has nine primary dimensions for monitoring the management of all medical equipment [6].

These dimensions are organized into phases and include planning, budget and financing, technology assessment, procurement and logistics, installation and commissioning, training and skill development, operation and safety, maintenance and repair, and decommissioning and disposal. The process begins with planning for the acquisition of medical equipment, after which an appropriate budgetary allocation and sourcing for funds are done.

As a government policy, a thorough technological assessment is done to this equipment in terms of its compatibility with expected use. The buying process is then subjected to an open and competitive bidding process. After buying, the equipment is installed and commissioned by relevant authorities. The personnel expected to operate the equipment are equipped with relevant skills through a series of training programs on operational functionality and safety standards [13]. Periodically, the equipment has to be subjected to maintenance and repair until its half-life expires, after which it is disposed of in an appropriate manner.

Gaps

It is imperative to observe that these processes since they cover direct outcomes and general environmental or social factors such as toxic chemicals, work accidents, and noise, among others, in the use of medical equipment. Despite the fact that these indicators present a comprehensive picture of the nature of UAE’s progress in facilitating a sustainable medical equipment management lifecycle, they do not explain the approaches or strategies in place to implement and sustain their application [3]. It is, therefore, in order to argue that sustainable systems of healthcare providers should be more detailed than just a list of subsections. Specifically, the procurement and disposal strategies are still not adequate due to limitations of law and expertise [12].

Systems and Solutions

In the UAE, a series of studies have been carried out to examine the best strategies for reforming the current healthcare equipment management system. Using Maslow’s hierarchy of needs model, as captures in figure 2, healthcare sustainability indicators have been arranged into 5 core factors of optimal health, health enhancement, medical necessity needs, basic healthcare needs, and environmental health needs [7] as solutions to the challenges faced.

As explained in this pyramid, lower needs are given the first priority over the upper needs because their impacts are felt at individual and society level. This model accommodates the structures and accounts associated with the five health need categories [6]. This means that any strategy aimed at expanding the scope of system sustainability in healthcare equipment management in UAE should factor in the environmental health concerns to promote a functional implementation approach [9].

The government of the UAE, through different healthcare authorities, has been at the forefront in organizing public debates and campaigns to establish and implement short and long-term sustainable approach towards modeling the health equipment management [3]. However, this assumption might prove unrealistic in the long run. For instance, lack of expertise might make implementation of these indictors challenging [1]. Moreover, the continuous problematic biodiversity loss has attracted multiple interdependencies is an indication that healthcare needs cannot be satisfied independently one after another [4]. This means that an effective healthcare equipment management sustainability approach should be holistic, inclusive and continuous for all the indicators.

UAE Medical Equipment Management

The UAE medical equipment management incorporates long-term strategic innovativeness, health promotion and disease prevention, institutionalization of environmental factors in use and disposal, quality, and individual responsibility or institutional accountability [19].

Process

From a sustainable healthcare system perspective, the aspect of long-term strategic innovativeness represents the planning, budgeting, and financing phase. In this case, the political actors and other stakeholders have the mandate of policy formulation and follow-up of the implementation process since these groups have the authority to make decisions to regulate the rules of managing medical equipment.

In relation to the UAE healthcare sector, this approach has been modified to manage the financial costs of medical equipment at optimal level [2]. There are budgetary allocations every year by the government to ensure that appropriate initiatives are put in place on use of equipment that match the investment and needs of patients. These incentives are necessary to regulate the ever escalating costs through bulk buying, direct price controls, and balanced reduction in the demand for certain equipment through public awareness campaigns. Moreover, there are systems in place to holistically and proactively perform cost-control as a management procedure [9].

Another initiative under the innovativeness is a continuous strategic review of the progress at the level of policy formulation in equipment use and disposal. Although it is a working process, the government of the UAE and other healthcare stakeholders has reduced the incremental decision-making approach in favor of long-term plans through strategic healthcare reforms in the use and disposal of medical equipment [6].

At present, the primary strategic management approach has been modeled into a realistic review of the current position in healthcare provision followed by putting in place detailed, clear, and long-term goals for achieving these plans [4]. For instance, there are policies in place to balance the financial and social imperatives and regulate tradeoffs in acquisition or leasing of medical equipment [20]. Over the years, the stakeholders in UAE have put in place systems for fostering consensus among the stakeholders and participative deliberations to make the medical equipment management reforms acceptable to all parties involved.

Another dimension of long-term innovativeness in the UAE healthcare sector is the deliberate attempt to maximize the system’s creativity in the use of medical equipment [17], [4], [9]. At present, there are a series of technological and scientific innovativeness strategies to ensure that the medical equipment is capable of contributing to improved services, reduction of administrative barriers, and development of effective pharmaceuticals [2], [6], [11].

In the healthcare service industry, innovation is an integral element for ensuring the ability to accomplish long-term competitiveness and stability. In order to accomplish this perspective, the public and private stakeholders in UAE have launched or finance a series of innovating models for seeking or allocating funds for purchase, replacement, service, and disposal of medical equipment [13]. In addition, there are strategies in place to strengthen the private healthcare sector, reduce user fees, and separation of high-cost care and long-term care through incentives and subsidies in the purchase of medical equipment [15].

Gaps

Several policies and practical initiatives have been rolled out by the government of the UAE to promote health institutional accountability and individual responsibility in the management and use of medical equipment. However, these policies are not adequate in encouraging transparency with clearly distributed competencies [18], accountability in resource allocation and use [9], and optimized stakeholder engagement in the management of medical equipment [14].

As established by Braithwaite, Marks and Taylor [13], there are initiatives in place to empower the workforce focused on motivating them to be part of the sustainable equipment use [18]. However, these periodic campaigns are not well organized by the stakeholders to encourage proactive engagement and consistency in the management of medical equipment.

Systems and Solutions

The term quality in medical equipment management is the “the degree to which health care services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge” [11] (p. 458). There are several indicators for quantifying quality aspects such outcomes, processes and structure of a medical equipment management charter [12]. Khan, Ajmal, Hussain and Helo [11] examined a series of healthcare frameworks of a dozen countries for dimension of performance in medical equipment management using system performance conceptual framework embedded in a wider indicator matrix. The findings revealed that the primary dimensions of quality are safety, effectiveness, and patient-centeredness or responsiveness [11].

The other additional performance indicators identified in this study are governance, care for amenities and environment, and continuity [11]. This case study established the significant link between sustainability of a medical equipment management approach and quality. The authors concluded that quality is an instrumental determinant of sustainability since its absence would lower the level of acceptance among the stakeholders. In the UAE healthcare sector, investments in health-related communication and information technologies have become important in order to connect the medical equipment management charter with modern conventional practices [18], [3], [13].

At present, the state of art technological support has become a norm and a standard for measuring efficiency in public and private healthcare facilities in UAE [9] to facilitate effective big data analysis in continuous assessment of patients. Although variances in healthcare service charter in terms of under-treatment and over-treatment are still a challenge in UAE, there is a policy in place to reduce this unwarranted variation.

This policy monitors how the burden of services in healthcare facilities is distributed through integration of affordable medical equipment technology. The results are then used to re-allocate resources and setup regional targets to implement easy and affordable payment systems [7]. Moreover, this policy has attempted to reduce inequality through increased accessibility of service according to the needs of each patient [5], [17]. The healthcare facilities have been empowered and improved to reduce the patient waiting time and avoid discrimination of the vulnerable or minorities at local, regional, and state levels [11] through use of efficient medical equipment.

Sustainability in Medical Equipment Management

Apparently, an attempt to institutionalize environmental concerns in medical equipment use and disposal in a healthcare system should integrate the social and ecological environments [10]. This means that addressing environmental concerns in a structured manner involves internalization of a holistic connection of these two environments to avoid healthcare inequalities at local, regional, and state levels [19], [8], [15].

Specifically, at policy level, the institutionalization of environmental concern should be accompanied by concrete measures rather than certain values [14]. For instance, a systematic integration of social issues in the use and disposal of medical equipment would balance the interdependencies and create sustainable direct and indirect intervention mechanisms [1]. This means that individual and community networks should be integrated in a holistic manner for optimal outcome [4].

In order to effectively remodel a sustainable system of medical equipment management, it is necessary to include the cultural and socio-economic variables associated with health such as social status, education, income, and associations with organizations and other units of the society [19]. The environmental factors are associated with about 14% of the disease burden in UAE, quantified in lost years of healthy life [9].

Moreover, the significance of biodiversity in pharmaceutical production or other medical practices should also be addressed [18], [19]. In the UAE, the government has come up with a policy to minimize the use of non-disposable in favor of disposable items and equipment. There is also a three-tier approach aimed at convincing the stakeholders through political, communication, and change of behavior measures [11], [16], [12]. In addition, the government continues to encourage the stakeholders to adapt green healthcare provision approaches such as use of modern equipment that are friendly to the environment such as solar technology.

Wellness and disease prevention programs are a prerequisite for sustainability in any healthcare system, especially those contributed by contamination of medical equipment [20], [18]. In order to strengthen the wellness promotion and disease prevention activities, a healthcare system should adjust its primary health facilities to incorporate the right medical equipment. This is because these facilities are capable of solving challenges at inception and facilitate any preventive mechanism [19].

This means that a sustainable healthcare system should emphasize on establishment of a strong model for its primary care facilities to facilitate accessibility, patient focus, and provision of comprehensive services [16]. In relation to UAE, there are systems in place to ensure that adequate medical equipment are in place through a public-private partnership approach [13] [14]. This system also integrates training of the healthcare workforce in UAE, especially in use of different medical equipment.

The rationale for this approach is to optimize the level of workforce morale and commitment, which is significant in provision of high quality and holistic services. In order to achieve this, the government has put in place strategic actions of recruiting adequate staff, competitive remuneration, and flexible or friendly work environment.

Summary and Conclusion

Apparently, the UAE healthcare sector has systems for promoting sustainability at policy and action levels in medical equipment management. However, these approaches face the challenge of financial, social, and ecological pressures. From the review of a series of exemplary approaches, case studies, theoretical, and empirical information, five basic principles of medical equipment management sustainability as related to UAE were outlined.

For instance, efficiency and effectiveness of treatment might result in lowered costs and improved financial stability or lowered energy consumption in the long run when the right equipment is used. Therefore, there is a need for a further research to relate the explicit and implicit effects of the current challenges in medical equipment management in UAE towards a sustainable healthcare approach.

Specifically, it is necessary to examine the extent to which the currently differentiated medical equipment management focus in UAE is aligned to the contemporary economic, social, and environmental pillars. Moreover, it would be significant to create a sustainability medical equipment index to allow for a regional comparative review of different aspects of sustainable health services in UAE.

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