Patricia McWalter (pictured) MD, MRCPI, FRCGP, Abdullah AlKhenizan MD, CCFP, FCFP, ABHPM, MSc, DCEpid and Aneela Hussain MD, DABFM, FAAFM are physicians in the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
We are a very diverse group of primary care physicians, serving a very diverse population of patients, in a leading medical and academic institute in Saudi Arabia. Our physicians have trained all over the world and have brought not only their clinical skills, but also their academic and teaching skills to the department. Our family medicine population is nearly 30,000 patients. We have exposure to much pathology, both common and rare. We have a catchment community based population with records for up to 40 years, which doesn’t exist in the region, as well as computerised medical records being used for 14 years, giving us the opportunity to access and research data from our population
Our institute has its own Research Advisory Council (RAC) to promote, regulate and monitor all aspects of research activities. All research proposals must be approved by the Clinical Research Committee and the Research Ethics Committee within RAC. We have therefore worked hard over the last couple of years to embark on primary care research activities, which has been both rewarding and demanding.
The positive aspects of primary care research in our department are many. Our research team, including our doctors and research coordinators, work together, alongside our specialist colleagues and dedicated researchers from the research center, to create research projects, which are of relevance to our patients. Some of the projects we have been working on, in our department, include creating a chronic disease registry (CDR), folic acid use in our pregnant patients, significance of hypovitaminoisis D among the Saudi population, attitudes towards HPV vaccination in primary care, experience of treating vaginismus in a Saudi population, verifying insulin strategy and initial health outcome analysis, and preventive healthcare among elderly women. Research enhances our education and knowledge and improves the quality of care we deliver to our patients. Some of our doctors have done research with other institutes in the country and further afield and this collaborative approach has strengthened our department’s commitment to research. We also have an option to apply for grants which are funded by a few local independent scientific organisations e.g. KACST (King Abdulaziz City for Science and Technology). As we embark on a family medicine residency training programme, we believe our research endeavors will grow. The experience gained from doing research can pave the way for those interested in a more academic career.
We do, of course, face some challenges and difficulties, in our pursuit to advance our research activities. Time constraints will always be a major challenge. Our clinics are always very busy, with little time to engage in research during the working week. Therefore many doctors will use their own time to engage in research, which can impact negatively on one’s personal life. We all know the financial gains are limited. We may also face reluctance from our patients to get involved-this is usually related to a lack of education and awareness about the importance of research in developing primary care further. We also need to develop a more computerized approach to data entry, which is extremely important for successful research.
Despite the challenges and difficulties, I believe research in our department and in primary care as a whole will continue and with better IT systems in the future, grow and expand. There will always be clinicians and health care professionals who have a burning desire to answer questions that only research can address. But in order to facilitate this, we must work as a team, in a highly supportive environment and reward those who put time and energy into a pursuit which is enormously beneficial to the development of primary care.
This blog is part of a series on global primary care research that CMAJBlogs is publishing in the lead-up to the NAPCRG Annual Meeting 2014
Thank you for sharing this online; it is a pleasure to reply with some points that I would like to share. Because my PhD research is about “the role of intangible resources in improving quality of care in acute hospitals”, I will reply from an intangibles’ perspective.
I was going through your article on the blog and I was able to identify many, if not all, factors as intangibles. The term ‘intangibles’ is defined as the kind of resources that does not have a physical existence but is still of value to an organization .
Such resources might include clinical skills, teaching skills, clinical database, IT systems and external relationships with other institutes. All these resources are considered important in knowledge-based organizations such as hospitals [2-5].
Nevertheless, research activities are also an intangible resource that can raise health care standards. I agree with your statement: “Research enhances our education and knowledge and improves the quality of care we deliver to our patients”. Indeed, research has an impact on knowledge, which should positively reflect on the quality of care. However, in order to achieve better intangible resource management and maximize their use for delivering better health care quality, we need to understand how the above resources interact.
The outcomes of research and development can provide healthcare professionals with up-to-date clinical knowledge that will help doctors make evidence-based decisions regarding diagnosis and treatment plans. This needs accurate patient data and easy access/user friendly IT systems.
Being familiar with both healthcare systems in Saudi Arabia and England, and based on the perspectives of healthcare professionals working in both settings (based on data obtained through semi-structured interviews as part of my PhD study), both Saudi Arabia and England seem to be facing difficulties in obtaining reliable data and dealing with complicated IT systems. They believe that this challenge can be overcome through direct contact with IT system developers to build systems based on their needs and train people working in health care on data collection and analysis techniques to ensure better outcomes.
In addition, focusing on personal contacts could promote the level of collaboration. Personal contacts of doctors working at KFSHRC with academic staff in the universities can provide a foundation for formal collaboration with universities and university hospitals to share data and research skills.
Also R&D awareness has been growing in the private sector. Some private hospitals have already established medical schools to invest their medical staff knowledge in teaching and research activities. One example is the partnership of Al Dar Hospital in Madinah and Al Rayyan Medical Colleges (still under construction). Another example is Saudi German Health Care Group and Al Batarji Medical College in Jeddah. These partnerships in the private sector will help encouraging the R&D practice and might be extended to the public sector.
There are different aspects about managing intangibles in organizations but I believe the key factor is to understand how different intangible resources intertwine within an organization. It may be worth looking at a study done by Pike et al. (2005) on visualizing how the dynamics of intangible resources can be useful in managing intangible resources in R&D organizations.
Indeed, focusing on teamwork, supportive environments and rewarding systems are main factors for success. However, it might be useful to look at a study by Carr et al. (2014), which identified the dimensions of research readiness in primary care.
Regarding time constraints, I think there should be more of a commitment from hospital senior level management towards R&D and to facilitate doctors’ involvement as well as to spread the culture of R&D, especially because KFSHRC recruits doctors whom have worked in the U.S, Canada and the UK. Those doctors have experienced the benefits of R&D and, therefore, the hospital management should encourage their experience with other hospital staff.
Regarding patient involvement, I think culture is playing a major role in keeping patients from participating. The Saudi society is conservative by nature and people do not adopt new ideas quickly. However, I believe increasing patients’ awareness of the benefits for them being involved in R&D can encourage more involvement. Additionally, it might be encouraging to explain how their involvement can be beneficial to them as well as to others, who might become ill with similar diseases, and how their involvement can lead to new cures and improved care.
Finally, I believe there is more to be done to take the R&D a step forward in the Saudi healthcare system. However, KFSHRC is still an independent body; the key factor is to focus on establishing formal collaboration agreements with medical schools in the area of sharing knowledge and skills.
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Thank you Dr Hussain for this very interesting overview on the importance of intangible resources in research. I particularly liked your suggestions about encouraging patient involvement, and liaising with medical schools. Thank you again