Building the health workforce: Saudi Arabia's challenges in achieving Vision 2030

Women's access to healthcare services in the Jazan region of the KSA

Objective

Our study investigated women's access to governmental healthcare in the Jazan region of the KSA. Our purpose is to provide a comprehensive analysis of the determinates of women's perceptions of their own access to healthcare, considering various demographic factors, family life, and gender role beliefs.

Methods

We conducted a hierarchical regression analysis using data from a sample of 494 women. The first model included nationality, education, age, rurality, and other sociodemographic factors. The second model included the variables from the first model as well as self-ratings of physical and mental health and regular exercise. The third model included the variables from the first two models in addition to satisfaction with family life and gender role beliefs.

Results

Our analysis revealed that age, nationality, employment, and having good physical and mental health, and satisfaction with family life positively predicted women's perceptions of their access to healthcare. Adherence to traditional gender roles, however, predicted less accessibility.

Conclusion

Policymakers could use the outcomes of our study to enhance women's healthcare accessibility in Jazan region. The results could enhance the development and transformation of healthcare and women's health issues, particularly in understudied rural Saudi regions.

Workforce estimate to treat mental disorders in the Kingdom of Saudi Arabia

BACKGROUND

Mental, neurological, and substance abuse (MNS) disorders describe a range of conditions that affect the brain and cause distress or functional impairment. In the Middle East and North Africa (MENA), MNS disorders make up 10.88 percent of the burden of disease as measured in disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) is one of the main providers of mental health services and one of the largest contributors to mental health research in the region. Within the past decade, mental health resources and services has increased.

METHODS

We employ a needs-based workforce estimate as a planning exercise to arrive at the total number of psychiatrists, nurses, and psychosocial care providers needed to meet the epidemiological need of mental health conditions of the population of KSA. Estimates for a potential mental health workforce gap were calculated using five steps: Step 1-Quantify target population for priority mental health conditions. Step 2-Identify number of expected cases per year. Step 3-Set target service coverage for each condition. Step 4-Estimate cost-effective health care service resource utilization for each condition. Step 5-Estimate service resources needed for each condition.

RESULTS

The planning exercise indicates an epidemiologic need for a total of 17,100 full-time-equivalent (FTE) health care providers to treat priority MNS disorders. KSA appears to have a need-based shortage of 10,400 health workers to treat mental disorders. A total of 100 psychiatrists, 5700 nurses, and 4500 psychosocial care providers would be additionally needed (that is, above and beyond current levels) to address the priority mental health conditions. The shortfall is particularly severe for nurses and psychosocial workers who make up 98.9 percent of the shortfall. This shortage is substantial when compared to other high-income countries. Overall, the workforce needed to treat MNS conditions translates to 49.2 health workers per 100,000 population.

CONCLUSION

Challenges to addressing the shortfall are Saudi specific which includes awareness of cultural customs and norms in the medical setting. These challenges are compounded by the lack of Saudi nationals in the mental health workforce. Saudi nationals make up 29.5 percent of the physician workforce and 38.8 percent of the nursing workforce. Policymakers and planners supplement this shortfall with non-Saudi providers, who must be mindful of Saudi-specific cultural considerations. Potential solutions to reducing the shortfall of mental health care workers includes nurse task shifting and training of general practitioners to screen for, and treat, a subset of MNS disorders.

Understanding person-centered care within a complex social context: A qualitative study of Saudi Arabian acute care nursing

Policy reforms implemented in Saudi Arabia in recent years aim to modernize the culture and infrastructure of healthcare delivery and are expected to integrate person- and patient-centered care principles throughout the national healthcare system. However, in a complex multicultural environment where most nurses are international migrant workers, unique challenges emerge that frame the delivery of care. Better understanding is needed about what nurses perceive to be high-quality, person-centered care in Saudi Arabia and how they manage to enact it in practice. Semi-structured interviews were conducted with 21 nurses working in two tertiary hospitals in Riyadh, the capital city. Participants included Saudi citizens (n = 9) and expatriates (n = 12) who were asked to describe their perceptions of quality nursing care and explain the obstacles that they encounter in providing such care. Nurses reported extensive efforts to achieve individualized, empathetic, developmentally appropriate care. Their descriptions of care aligned with principles of patient-centeredness in care but were not separable from challenges at the patient, organizational, and regional levels, including staffing and supplies shortages, gaps in regional care coordination, inadequate language translation services, variability in cultural beliefs about healthcare communication, and overt discrimination against expatriate workers. Nurses reported creative strategies to achieve professional nursing values while navigating a dynamic landscape of constraints. The findings add to literature suggesting that person-centeredness in care cannot be understood outside the social and organizational conditions that shape it.

Key aspects of the Saudi healthcare system reform and the potential impact on the main stakeholders: A qualitative study

Objectives

To explore and understand KSA's fundamental healthcare system reform, the potential changes and challenges, and their impacts on major stakeholders.

Methodology

To gain in-depth insights into healthcare leaders' perspectives regarding healthcare system reform in KSA, a qualitative research approach was used. Ten participants from diverse backgrounds were selected, representing various sectors in KSA: private, public, executive, consulting, and regulatory. This study was conducted between august 2022 and June 2023.

Findings

The findings revealed four key themes that shed light on healthcare system transformation in KSA and its effects: healthcare system reform, the impact of corporatization/privatization on healthcare providers, the impact of corporatization/privatization on health insurance, and the impact of corporatization/privatization on the workforce. Furthermore, the findings indicated that the ongoing transformation of the public sector toward privatization in KSA faces various challenges that affect most, if not all, stakeholders in the sector. However, the private sector possesses several strengths that can aid in addressing the challenges associated with the rapid transformation of the system. These strengths include familiarity with the market, robust financial management, extensive experience in coding and billing payers and insurance companies, efficient decision-making processes, flexibility, and maturity.

Conclusion

The study facilitated comprehensive insights into the transformation of KSA's healthcare system and the public sector's shift toward corporatization/privatization. The sector must enhance its capabilities by establishing specialized units and recruiting talent. Further studies are also needed to gain a deeper understanding of the obstacles hindering the transformation.

Sociocultural and perceived public image of nurses among nursing students: the mediating role of self-concept

BACKGROUND

Studying the public perception of nurses among nursing students is vital in establishing strategic solutions to recruit and retain more students in nursing programs and to contain nurses in the health care system.

AIM

This study aimed to determine the mediating role of self-concept in the relationship between sociocultural and perceived public image of nurses.

METHODS

This study employed a correlational approach using convenience sampling of 1390 participants. This study was conducted at six large universities in three regions of Saudi Arabia (central, northern, and eastern). Student nurses in their second to fourth years of study were included as participants, with an 89.7% response rate. Data were collected from January to April 2023.

RESULTS

A significant positive relationship was observed between sociocultural factors and self-concept (r = .685, p = .0001). In addition, there was a significant positive relationship between self-concept and public image (PI) (r = .352, p value = 0.0001). Furthermore, there was a significant positive relationship between sociocultural and public image (r = .456, p = .0001); sociocultural had a direct effect on self-concept (β = 0.324, SE = 0.098, t = 9.429, p < .0001) and public image (β = 0.605, SE = 0.038, t = 22.617, p < .0001). Furthermore, sociocultural had an indirect effect on public image through self-concept (H6) (β = 0.389, SE = 0.123, t = 12.766, p < .0001).

DISCUSSION

The study findings suggest that nursing school programs should take measures to foster a supportive environment that promotes self-concept and public image, while also being mindful of the sociocultural background. This would also open the scope for further research on the matter involving multiple centers.

CONCLUSIONS

This study suggests the need for programs to boost self-concept and public image that consider sociocultural influences. These 'findings have crucial implications for student nurses' social and psychological wellbeing as they improve the understanding of how sociocultural affects self-concept and public image.

ChatGPT-3.5 System Usability Scale early assessment among Healthcare Workers: Horizons of adoption in medical practice

Artificial intelligence (AI) chatbots, such as ChatGPT, have widely invaded all domains of human life. They have the potential to transform healthcare future. However, their effective implementation hinges on healthcare workers' (HCWs) adoption and perceptions. This study aimed to evaluate HCWs usability of ChatGPT three months post-launch in Saudi Arabia using the System Usability Scale (SUS). A total of 194 HCWs participated in the survey. Forty-seven percent were satisfied with their usage, 57 % expressed moderate to high trust in its ability to generate medical decisions. 58 % expected ChatGPT would improve patients' outcomes, even though 84 % were optimistic of its potential to improve the future of healthcare practice. They expressed possible concerns like recommending harmful medical decisions and medicolegal implications. The overall mean SUS score was 64.52, equivalent to 50 % percentile rank, indicating high marginal acceptability of the system. The strongest positive predictors of high SUS scores were participants' belief in AI chatbot's benefits in medical research, self-rated familiarity with ChatGPT and self-rated computer skills proficiency. Participants' learnability and ease of use score correlated positively but weakly. On the other hand, medical students and interns had significantly high learnability scores compared to others, while ease of use scores correlated very strongly with participants' perception of positive impact of ChatGPT on the future of healthcare practice. Our findings highlight the HCWs' perceived marginal acceptance of ChatGPT at the current stage and their optimism of its potential in supporting them in future practice, especially in the research domain, in addition to humble ambition of its potential to improve patients' outcomes particularly in regard of medical decisions. On the other end, it underscores the need for ongoing efforts to build trust and address ethical and legal concerns of AI implications in healthcare. The study contributes to the growing body of literature on AI chatbots in healthcare, especially addressing its future improvement strategies and provides insights for policymakers and healthcare providers about the potential benefits and challenges of implementing them in their practice.

Factors Affecting the Satisfaction of Women Employees in Health Sector: A Perception Study in Saudi Arabia

Purpose

Broad evidence points out that women workers in Saudi Arabia face a range of inequitable work practices despite continued efforts for gender equality. The study aims to assess the satisfaction of Saudi women working in the health sector among certain factors in the work environment, factors that enable them to gain opportunities and benefits and make decisions.

Patients and Methods

This is a cross-sectional study, which involved the use of closed-ended surveys on 261 Saudi women working in the healthcare sector.

Results

Most of the females were aged between 25 and 34 years (59%) and more than half of them worked in the governmental sector (53%). Fifty-eight percent of the females hold clinical jobs, 25% of the administrative jobs were 37% of them have more than 19 years of working experience. The finding showed a significant association between female workers in health sector satisfaction with factors related to the workplace environment, training, and development, and their involvement in decision-making.

Conclusion

Most women felt empowered when they received equitable tasks and were able to reach managerial-level positions in their organizations. Establishing a positive work environment characterized by opportunities has the potential to enhance women workers' satisfaction.

An analysis of pharmacy workforce capacity in Saudi Arabia

Background: Previous reports have highlighted the core issues with the intelligence of the national pharmacy workforce reliance on non-native pharmacists, despite the increasing supply of local pharmacy graduates; limited participation of female pharmacists in the workforce; and inadequate proportions of pharmacists in primary healthcare centres, resulting in pharmaceutical services being provided without a pharmacist's supervision. Methods: The current study used a retrospective cross-sectional design and data was collected from January to May 2023. Data was retrieved from the Health Statistics Yearbook, 2017, 2018, 2019, 2020 and 2021. The data included the total number of pharmacists, the number of Saudi pharmacists, the number of foreign pharmacists, the distribution of the proportions of male and female pharmacists, and the distribution of the workforce by region, sector and nationality. Data was also obtained relating to pharmacy education, including the number of pharmacy colleges, the number of pharmacy students and the number of pharmacy graduates. Results and conclusion: The capacity of the pharmacy workforce, meaning the number of pharmacists per 10,000 population, fluctuated between 2017 and 2021, with the lowest number being in 2020, a mere 7.9 pharmacists per 10,000 population. However, in 2021, the overall density of pharmacists increased to (9.04), which is above the global average (7.36 per 10,000 population). The proportion of women working in the pharmacy profession increased from 12% to 22%, and in community pharmacies from 0.3% to 7.2%, between 2016 and 2021. Another issue that still exists is a lack of proportionate and imbalance in the distribution of the pharmacy workforce across the regions. The renationalisation initiatives increased the overall proportion of Saudi pharmacists to 39% in 2021, compared to 22% in 2016. There is a need for a policy mechanism that will overcome the identified issues.

Attitudes towards death and dying among intensive care professionals: A cross-sectional design evaluating culture-related differential item functioning of the frommelt attitudes toward care of the dying instrument

Objective

The objective is to examine whether one of the most used instruments for measuring attitudes towards caring for dying patients, the Frommelt Attitude Toward Care of the Dying (FATCOD-B) instrument, has the same meaning across different societal contexts, as exemplified by Swedish and Saudi Arabian intensive care professionals.

Methods

A cross-sectional design used the 30-item FATCOD-B questionnaire. It was distributed to intensive care professionals from Sweden and Saudi Arabia, generating a total sample of 227 participants. Ordinal logistic regression models were used to examine the differential item functioning (DIF) for each item.

Results

Up to 12 of the 30 items were found to have significant DIF values related to: (a) Swedish and Saudi Arabian intensive care professionals, (b) Swedish and Saudi Arabian registered nurses (RNs), (c) RNs' levels of experience and (d) RNs and other intensive care professionals in Saudi Arabia.

Conclusions

The results indicate that FATCOD should be used cautiously when comparing attitudes towards death and dying across different societal and healthcare contexts.

Health care overbooking cost minimization model

Challenges in the health care industry have confounded the provision of quality services for patients. Among many relevant concerns, the drive for cost-effectiveness and efficient care have placed considerable pressure on public health care systems and insurance coverage, amid existing barriers to restructuring entrenched systems. This study closely examines the factors impacting disruptions in health care scheduling systems using a structured case study in the health care industry. The study introduces a novel model to identify optimal overbooking capacity and minimize no-show costs. To address the complexity of this issue on a smaller scale, the model is implemented using a private hospital clinical platform in Jeddah, Saudi Arabia, instituting an overbooking reservation and queuing system in 14 departments to investigate the factors that influence disruptions and inefficacy of service provision, while also introducing a strategy for covering costs. The results identify the maximum amount of overbooking that can be made for each clinic. The cost-saving plan developed is expected to save each clinic a considerable sum, as opposed to randomly overbooking without any cost assumptions. Overall, if the clinics studied implemented this strategy, a total loss of no more than SAR. 2, 408 would be incurred from overbooking, in contrast to the exponentially growing amount of SAR. 10,000 that is currently lost on scheduling errors per year. The loss model developed has practical application as a tool for decision-making that includes no-show cost minimization variables.

A cross-sectional study factors associated with resilience among medical staff in radiology departments during COVID-19, Riyadh, Kingdom of Saudi Arabia

OBJECTIVES

This study aims to assess the level of resilience of medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia, during the COVID-19 outbreak and to explore associated factors.

SETTING

Medical staff, including nurses, technicians, radiology specialists and physicians, working in radiology departments at government hospitals in Riyadh, Saudi Arabia during the COVID-19 outbreak.

DESIGN

A cross-sectional study.

PARTICIPANTS

The study was conducted among 375 medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia. The data collection took place from 15 February 2022 to 31 March 2022.

RESULTS

The total resilience score was 29.37±6.760 and the scores of each dimension showed that the higher mean score was observed in the domain of 'flexibility', while the lowest was observed in 'maintaining attention under stress'. Pearson's correlation analysis showed that there was a significant negative correlation between resilience and perceived stress (r=-0.498, p<0.001). Finally, based on multiple linear regression analysis, factors affecting resilience among participants are the availability of psychological hotline (available, B=2.604, p<0.050), knowledge of COVID-19 protective measures (part of understanding, B=-5.283, p<0.001), availability of adequate protective materials (partial shortage, B=-2.237, p<0.050), stress (B=-0.837, p<0.001) and education (postgraduate, B=-1.812, p<0.050).

CONCLUSIONS

This study sheds light on the level of resilience and the factors that contribute to resilience in radiology medical staff. Moderate levels of resilience call for health administrators to focus on developing strategies that can effectively help cope with workplace adversities.

A Decade's Perspective on the Orthopedic Workforce in Saudi Arabia

Background The orthopedic surgery workforce constitutes a vital role in the healthcare system, with data being scarce. Therefore, through this study, we share an overview of the orthopedic workforce distribution, demographic trends, and changes over the past decade in Saudi Arabia. Methods All practicing orthopedic surgeons in Saudi Arabia from January 1, 2010, to December 31, 2021, were included in the study. Data regarding orthopedic surgeons' demographics and numbers were obtained from the Saudi Commission for Health Specialties (SCFHS), whereas the data related to the geographical distribution of orthopedic surgeons was obtained from the Ministry of Health Statistical Yearbook of 2020. Results The ratio of orthopedic surgeons per 100,000 people was 5.42 in 2010, which grew subsequently to 12.29 in 2021. The number of Saudi orthopedic surgeons has been noticeably rising through the years, while a slowly growing pattern can be seen among non-Saudi orthopedic surgeons. In addition, the highest ratios of orthopedic surgeons per 100,000 were in Makkah (1.72), Riyadh (1.26), and the Eastern Region (1.06). Conclusion In this study, we demonstrate the progress of the orthopedic workforce in Saudi Arabia over a period of 12 years. The number of orthopedic surgeons per 100,000 people showed a significant rise due to several factors, one of which is road traffic accidents. Also, although the number of female orthopedic surgeons has been rising lately, they are still much fewer than males in this field. In addition, Saudi Arabia has been developing a new healthcare system via the privatization of some of the governmental hospitals, which will lead to changes in the future workforce and its accommodations.

Health System Financing: A Comparative Analysis of India and Saudi Arabia

The objective of this study is to provide a comparative analysis of the health financing systems in India and the Kingdom of Saudi Arabia (KSA) across three major domains: resource mobilisation, pooling of resources and purchase of health services. This is an observational study using secondary data collected from international organisations, ministries of health and other government and non-government agencies in India and KSA. The study revealed that India has a very low expenditure on healthcare and markedly lower health outcomes compared to KSA. Although India’s health financing system has undergone notable changes in the last two decades, it is lagging behind in many health financing system parameters. However, the share of government expenditure on current health expenditure has been increasing steadily with higher allocations to primary and secondary care. By expanding health insurance coverage and sustainable public health funding, it is likely that India will make significant progress towards achieving UHC.

Unlocking the eHealth professionals' career pathways: A case of Gulf Cooperation Council countries

BACKGROUND

During the past two decades, various sectors and industries have undergone digital transformation. Healthcare is poised to make a full transformation in the near future. Although steps have been taken toward creating an infrastructure for digital health in the Middle East, as it stands, digital health is still an emerging field here. The current global health care crisis has underscoredthe need for digitization of the healthcare sector to provide high-value, high-quality care and knowledge generation. With the advent of digital transformation in countries around the globe, there is a rising demand for investment and innovation in health information technology. With the demand for health informatics (HI) graduates in different disciplines (e.g., healthcare professions, information technology, etc.), there is an urgent need to determine and regulate clear career pathways and the core competencies necessary for digital health professional to practice effectively and to allow technology to add value to the healthcare systems. Given the changing landscape of the profession, the Kingdom of Saudi Arabia (KSA) and the Gulf Cooperation Council (GCC) countries are experiencing a rising demand to produce digital health professionals who can meet the needs of all the stakeholders involved, including patients, healthcare professionals, managers, and policymakers. However, despite the number of region-wide initiatives in the form of training programs, there remains a knowledge-practice gap and unclear job roles within the HI community. In recent years, regional digital health workforce initiatives have been put forward, such as the GCC Taskforce on Workforce Development in Digital Healthcare. The taskforce initiated a survey and several workshops to identify and classify HI disciplines according to the needs of the job market and through comparisons with similar efforts developed across the globe, such as the TIGER project and the EU*US eHealth Work project. Digital health implementation has been flourishing in the Middle East for the past 15 years. During this period, while digital health professions have been thriving in the industry to deliver tools and technologies, academic institutions have offered some amount of training and education in digital health; however, the career pathway for digital health professionals is not clear due to mismatch about the qualifications, skills, competencies and experience needed by the healthcare industry.

OBJECTIVES

Due to this discrepancy between the academic curriculum and the skills needed in the healthcare industry, the objectives of this study are to define the career pathway for eHealth professions and identify the challenges experienced by academic institutions and the industry in describing digital health professionals.

METHODS

We elicited qualitative data by conducting six focus groups with individuals from different professional backgrounds, including healthcare workers, information managers, computer sciences professionals, and workers in the revenue cycle who participated in a workshop on November 2-3, 2019, in Dubai. All focus group sessions were audio-recorded and transcribed, and participants were de-identified before analysis. An exploratory method was used to identify themes and subthemes. Saturation was reached when similar responses were found during the analysis. In this study, we found that respondents clearly defined eHealth career pathways based on criteria that included qualifications, experience, job scope, and competency. We also explored the challenges that the respondents encountered, including differences in the required skill sets and training and the need to standardize the academic curriculum across the GCC region, to recognize the various career pathways, and to develop local training programs. Additionally, country-specific projects have been initiated, such as the competency-based Digital Health framework, which was developed by the Saudi Commission of Healthcare Specialties (SCFHS) in 2018. Competency-based digital health frameworks generally include relevant job definitions, roles, and recommended competencies. Both the GCC taskforce and the Saudi studies capitalized on previous efforts by professional organizations, including Canada's Digital Health formerly known as (COACH), the U.S. Office of the National Coordinator for Health Information Technology (ONC), the American Medical Informatics Association (AMIA), and the Health Information and Management Systems Society (HIMSS).

RESULTS

In this study, we found that respondents defined eHealth career pathways based on different criteria such as: qualifications; various background of health and IT in the HI field; work experiences; job scope and competency. We also further explore the challenges that the respondents encountered which delineates four key aspects such as need of hybrid skills to manage the digital transformation, need of standardization of academic curriculum across GCC, recognition of the career pathways by the industry in order to open up career opportunity and career advancement, and availability of local training programs for up-skilling the current health workforce.

CONCLUSION

We believe that successful health digital transformation is not limited to technology advancement but requires an adaptive change in: the related competency-based frameworks, the organisation of work and career paths for eHealth professionals, and the development of educational programmes and joint degrees to equip clinicians with understanding of technology, and informaticians with understanding of healthcare. We anticipate that this work will be expanded and adopted by relevant professional and scientific bodies in the GCC region.

Healthcare Transformation in Saudi Arabia: An Overview Since the Launch of Vision 2030

Saudi Arabia’s Vision 2030 has taken a centre stage in the development of its healthcare sector through privatization adopting Public Private Partnerships (PPPs). The objective of this study is to provide an overview of healthcare transformation in Saudi Arabia since the launch of the ambitious Vision 2030, identifying issues those need to be addressed and steps taken towards provision of health systems transformation. Literature review was based on extensive review of published and unpublished articles, where different search engines and databases searched using the key words: ‘Saudi Healthcare’, ‘Healthcare transformation’, ‘Saudi vision: 2030’, ‘Public-Private Partnerships’ and ‘Privatization’, in addition to secondary data as published in government reports, policy, government strategy documents and pertinent press releases. The future of the healthcare like many other developing economies continues to weigh policies for universal coverage while containing costs and the national transformation programme driven by social and economic factors has implemented strategic steps to develop its private healthcare system that includes: establishing health clusters, National Centre for Privatization & PPP – an official enabler for privatization of all government sectors and recently approved Private Sector Participation (PSP) Law involves several legislative enablers designed to enhance investor confidence in the privatization process. Although this study demonstrates systemic legislative progress to facilitate transformation process of healthcare sector, also endorses caution and research in identifying barriers to the implementation of PPPs, Saudi workforce development, implementing effective revenue cycle management function for healthcare reimbursement and ensuring vulnerable population access to good quality and tertiary healthcare. As healthcare of Saudi Arabia embarks on the transformation journey facing daunting challenges, but it appears that the government has laid out a roadmap with the legislative framework; however it is important that there is ongoing monitoring with adjustments as this complex and multifaceted process proceeds.

10 years of experience in adopting, implementing and evaluating progress testing for Saudi medical students

Objectives

The progress test (PT) is a comprehensive examination that is designed to match the knowledge acquisition necessary at graduation and monitors progress during the entire period of an undergraduate program. Qassim College of Medicine (QCM) began using the multi-institutional PT in the Kingdom of Saudi Arabia (KSA). This study aimed to determine if the PT can be utilized to assess the progress of medical students at different Saudi medical colleges with different educational approaches, as well as whether this testing modality could be accepted by other colleges.

Methods

Beside the establishment of a PT committee, comprehensive blueprinting was crafted to sample 200 A-type multiple choice questions (MCQs) from different disciplines. The PT is a paper-and-pencil model and is answered in a 4-h period. All PT items followed a uniform design.

Results

In total, 13 rounds of the progress test have been conducted. The number of participating colleges increased from three (with 285 students) in the first test (May 2012) to more than 20 (with >6000 students) in the ninth round (February 2017). The average % scores for first-year students ranged from 3.0% to 7.9% while the average scores for fifth-year students ranged from 34.0% to 43.0%.

Conclusion

The conduction of this meticulously crafted test to evaluate knowledge achievement at medical graduation is a fruitful tool and helps to provide constructive feedback for test-takers and other stakeholders relating to their relative positions among other fellows at the national level.

Attitudes and Perceptions of Health Leaders for the Quality Enhancement of Workforce in Saudi Arabia

BACKGROUND AND AIM

Besides the unique exposure and experience of health leaders in facing challenges and overcoming them, and the relatively fewer articles relating to the perception of health leaders in workforce quality enhancement, health leadership plays a crucial role in redirecting the workforce, increasing job satisfaction, professional development, and burnout prevention. Thus, this study aimed to understand the current healthcare workforce quality and future expectations from the attitudes and perceptions of health leaders.

METHODS

A qualitative research was carried out using semi-structured interviews consisting of 24 different questions. Participants of the study were healthcare leaders from different backgrounds and governmental institutions. All interviews were recorded, transcribed, and then analyzed using thematic analysis via the N-Vivo program.

RESULTS

Eleven participants were involved in the study, with one female and ten males. A thematic analysis and N-Vivo program yielded 5 main themes: (1) workforce competency, (2) health transformation, (3) leadership, (4) workforce planning, and (5) healthcare quality, with 22 emerging sub-themes. Moreover, participants responded with different attitudes and perceptions.

CONCLUSION

Health leaders are satisfied with the current direction of workforce competency and planning, yet fragmentation of the system and poor accessibility may need further enhancement. Furthermore, misutilization of services and the uncertainty of the future and talent pool are potential barriers for capability building. Moreover, with the existing gap in the workforce, health leaders believe that privatization and corporatization may have a positive effect. Aside from that, Saudization with the current plan of having a minimum standard of accepting non-Saudis in certain areas might benefit in maintaining competition and enriching experience. However, catching up with further research in healthcare quality in Saudi Arabia is needed because of the ongoing health transformation.

Dermatology workforce over a decade in Saudi Arabia: demographics, distributions, and future challenges

BACKGROUND

The dermatology workforce is an important topic, as many countries are facing an undersupply of dermatologists, while some are expecting a surplus. Therefore, we conducted this study to identify the current dermatology workforce demographics in Saudi Arabia (SA) and the changes in such demographics over the last 10 years to identify future workforce-related challenges.

METHODS

This study was conducted in SA, and it included all the practicing dermatologists in the country over the last decade (2010-2020). The number of practicing dermatologists, their gender, their nationality, and dermatology residency candidates and graduates were obtained from the Saudi Commission for Health Specialties (SCFHS). The geographic distribution of dermatologists was obtained from the Ministry of Health Statistical Yearbook 2018.

RESULTS

As of September 2020, there were 2678 practicing dermatologists in SA at a ratio of 7.82 dermatologists per 100 000 people. Of the 2678 dermatologists, only 24.8% were Saudis. The Saudi dermatologist ratio has been almost constant over 10 years, ranging from 1.3 to 1.9 per 100 000 people. Of all Saudi dermatologists, 42% were female. The number of residents who graduated from the residency program was not consistent for each year and ranged from 4 to 25. The number of dermatologists varied by region, with 9.2 in Riyadh and 3.4 in Najran per 100 000 people.

CONCLUSIONS

The results of our study revealed that a quarter of dermatologists in SA are Saudis. In addition, the number of non-Saudi dermatologists has increased in the last 10 years, while the number of Saudi dermatologists to the population has remained almost constant. There is also a geographic maldistribution of dermatologists, with urban areas having a higher number of dermatologists than rural areas. We encourage local studies that can elucidate the factors influencing the workforce, such as the dermatologist appointment waiting time, dermatologists' working hours, and the geographic maldistribution of dermatologists in the country.

Prevalence and Risk Factors of Occupational Health Hazards among Health Care Workers of Northern Saudi Arabia: A Multicenter Study

Health care workers (HCWs) working in different health care facilities are exposed to many hazards, especially during the COVID-19 pandemic. This questionnaire-based cross-sectional study aimed to assess the prevalence, pattern, and risk factors of occupational health hazards faced by 438 randomly selected HCWs from northern Saudi Arabia. The HCWs are commonly exposed to needle stick injuries (34.5%) under the biological hazards category; and work-related stress (69.6%) under the non-biological hazards categories. The significant associated factors were work setting (ref: Primary Health Center: Adjusted OR (AOR) = 2.81, 95%CI = 1.21-4.59, p = 0.017), smoking status (ref.: non-smoker: AOR = 1.73, 95%CI = 1.03-2.91, p = 0.039), and mean sleeping duration per day (AOR = 1.22, 95%CI = 1.04-1.43, p = 0.014) for biological, and smoking status (ref: non-smoker: AOR = 2.16, 95%CI = 1.09-3.29, p = 0.028), and mean sleeping duration per day (AOR = 1.35, 95%CI = 1.07-1.70, p = 0.013) for non-biological categories. This study revealed several risk factors and occupational health hazards that HCWs are exposed to during their work time. Periodic training and follow-up assessments regarding bio-safety measures for the HCWs should be implemented. Finally, future explorative studies are warranted on the feasibility of implementing rotation-based postings for the HCWs in different health care settings.

Factors that influence the preceptor role: a comparative study of Saudi and expatriate nurses

OBJECTIVES

The aim of this study was to compare expatriate and Saudi nursing staff's perceptions of factors that influence their role as preceptors of nursing students.

METHODS

Descriptive comparative study using a self-administered survey was completed by a convenience sample of eligible nurses (n=285). It was conducted in five different hospitals within the Ministry of Health in the Kingdom of Saudi Arabia.

RESULTS

Most preceptors were expatriate nurses (70.5%), while Saudi preceptors represented only 29.5%. The findings show that there is a difference between Saudi and expatriate nurses in their perception of the role, that cultural factors influence the role of expatriate preceptors and that organisational factors influence both groups.

CONCLUSIONS

Expatriate preceptors felt that there were cultural obstacles that hindered their role. These findings will contribute to the development of a more contemporary and culturally sensitive preceptorship model.

Challenges Facing the Nursing Profession in Saudi Arabia: An Integrative Review

There is a paucity of recent literature identifying the issues facing the nursing profession in Saudi Arabia. The aim of this integrative review is to highlight the ongoing challenges facing the nursing profession in Saudi Arabia despite attempts to make a difference and suggests recommendations for the future. Literature published from 2000 to 2020, inclusive, relevant for nursing challenges in Saudi Arabia was accessed and reviewed from multiple sources. In Saudi Arabia, inadequate numbers of Saudi nurses have prompted an increase in recruitment of expatriate nurses. This has created its own issues including, retention, lack of competency in English and Arabic, as well as Arabic cultural aspects, insufficient experience, and a high workload. The result is job dissatisfaction and increased attrition as these nurses prefer to move to more developed countries. For national nurses, the issues are the need to recruit more and retain these nurses. There are a range of cultural factors that contribute to these issues with national nurses. There is a need to improve the image of nursing to recruit more Saudi nurses as well as addressing issues in education and work environment. For expatriate nurses there is a need for a better recruitment processes, a thorough program of education to improve knowledge and skills to equip them to work and stay in Saudi. There is also a need for organizational changes to be made to increase the job satisfaction and retention of nurses generally. Healthcare in Saudi Arabia also needs leaders to efficiently manage the various issues associated with the nursing workforce challenges.

Vision 2030 and Sustainable Development: State Capacity to Revitalize the Healthcare System in Saudi Arabia

Vision 2030 is a social and economic strategic program by the Kingdom of Saudi Arabia (KSA) aimed at diversifying the nation's economy and stimulating numerous changes in its social and economic sectors, including in healthcare. Sustainable Development (SD) 2030 is a global consensual agreement among nation-states to build a sustainable, desirable and progressively interrelated world. The Saudi government highlighted Vision 2030 to improve population health and the world body reiterated that SD 2030 will contribute to "healthy lives and promote well-being for all at all ages." This article analyzes the state capacity in revitalizing the healthcare system in Saudi Arabia with the context of Vision 2030 and SD 2030. Scoping reviews and thematic data analysis techniques were used as a method of this study. The realization of Vision 2030 is essential for the fulfilment of the SD Goals 2030. The government has realigned its national programs, plans and strategies with global development targets, indicators, and goals to achieve the SD Goals. Achieving SD 2030 is seen as the main component of development for health. Prudent reforms should be taken to accommodate the goals and objectives of Vision 2030 and SD 2030. These measures will help strengthen governance and state capacity so as to ultimately revitalize the Saudi healthcare system and improve population health. Saudi Arabia's Vision 2030 encourages the state to play a renewed role in development in light of the UN's declaration of the "right to development." While pursuing SD Goals, the state must create the necessary environment for sustaining capacity, need to improve service delivery by building cooperation and coordination among providers and interactions among groups to realize constructive roles and functions in maintaining state affairs, which ultimately enhances state capacity to revitalize healthcare system of Saudi Arabia.

Challenges and policy opportunities in nursing in Saudi Arabia

BACKGROUND

The Kingdom of Saudi Arabia's (KSA) health sector is undergoing rapid reform in line with the National Transformation Program, as part of Saudi's vision for the future, Vision 2030. From a nursing human resources for health (HRH) perspective, there are challenges of low nursing school capacity, high employment of expatriates, labor market fragmentation, shortage of nurses in rural areas, uneven quality, and gender challenges.

CASE PRESENTATION

This case study summarizes Saudi Ministry of Health (MOH) and Saudi Health Council's (SHCs) evaluation of the current challenges facing the nursing profession in the KSA. We propose policy interventions to support the transformation of nursing into a profession that contributes to efficient, high-quality healthcare for every Saudi citizen. Key to the success of modernizing the Saudi workforce will be an improved pipeline of nurses that leads from middle and high school to nursing school; followed by a diverse career path that includes postgraduate education. To retain nurses in the profession, there are opportunities to make nursing practice more attractive and family friendly. Interventions include reducing shift length, redesigning the nursing team to add more allied health workers, and introducing locum tenens staffing to balance work-load. There are opportunities to modernize existing nurse postgraduate education, open new postgraduate programs in nursing, and create new positions and career paths for nurses such as telenursing, informatics, and quality. Rural pipelines should be created, with incentives and increased compensation packages for underserved areas.

CONCLUSIONS

Critical to these proposed reforms is the collaboration of the MOH with partners across the healthcare system, particularly the private sector. Human resources planning should be sector-wide and nursing leadership should be strengthened at all levels.

The Outcome of Unscreened Population in Colorectal Cancer: The Impact of Sex and Other Determinants on Cancer Stage

BACKGROUND

In Saudi Arabia, there is no population-based colorectal cancer (CRC) screening, and more than two-thirds of patients are diagnosed with a late stage. We assessed the association between sex and distant metastasis CRC and hypothesize that females, younger age, non-married, and patients with colon cancer would present with metastatic tumors.

PATIENTS AND METHODS

The retrospective cohort study used data from the Ministry of National Guard Cancer Registry. Logistic regression was used to assess the association between sex and metastatic CRC adjusting for patient covariates. In a sensitivity analysis, the association between sex and late-stage CRC was evaluated.

RESULTS

A total of 1016 CRC patients met the eligibility criteria, with 37.59% of females and 30.26% of males diagnosed with metastatic CRC. After adjusting for marital status, grade, and morphology, females were 20% more likely than males to present with a metastatic tumor 1.20 (95% CI, 1.04-1.38).

CONCLUSION

Although the entire Saudi population would benefit from CRC screening, women may benefit the most from targeted screening.