An Overview of the History and Development of Health Services Management Education, Training, and Practice in Saudi Arabia: Calling for Change
Keywords: Health education, Health services management, Saudi Arabia
The purpose of this article is to outline the history and development of health, services, management, training, and practice in Saudi Arabia and provide suggestions for enhancement of the development of the profession. A comprehensive descriptive needs assessment was conducted retrospectively through direct observation, online websites, interviews, and a review of existing documents from government agencies. Conducting a series of studies on the type and number of candidates required in this industry is essential for shaping the structure of education in health services management.
Healthcare managers play an important role in directing organizational resources to respond to population needs, and they are responsible for addressing gaps in healthcare access, effectiveness, and efficiency. The healthcare management profession offers direction to organizations that deliver personal health services and to the divisions, departments, units and services within those organizations (1, 2). As in many industries, managers in the healthcare field assume their positions after working in clinical or technical roles and sometimes continue in these roles along with their managerial duties.
The dynamic nature of the healthcare field influences managerial roles, and managers need to keep up-to-date with relevant developments to ensure that they can judge what action to take at a given time. The elements that create this dynamic nature include the ongoing reshaping of healthcare systems, policies, procedures, technological and medical innovations, changes in quality measurements, evidence-based practices, and economic fluctuations. Consequently, health service managers should have knowledge of relevant laws and regulations, a broad understanding of technology and innovations, and awareness of quality requirements.
Health service managers are also responsible for improving the quality of care and the level of efficiency in healthcare facilities. All countries face challenges in delivering high-quality, affordable healthcare (3), and the Kingdom of Saudi Arabia is no exception. The country is seeking to reform its healthcare system to improve the quality of care provided to citizens while controlling rising costs. Complexity arises from the need to balance medical services, business obligations, and community responsibility leading to the requirement of skilled managers who can use resources wisely and ensure that patients are well cared for. This article aims to describe the history and development of health services management training and practice in Saudi Arabia and to suggest directions for the development of the profession.
Health Services Management Education
The multidisciplinary nature of health services management has led to the expansion of healthcare management education programs around the world, and these programs face comparable challenges. Graduates of health services management programs often have no clear career pathways because the scope and roles of healthcare managers have expanded over time. These graduates stand a chance to get employed in government organizations managing the regulation and supervision of healthcare services (4). There are also opportunities in private hospitals and medical, pharmaceutical, and technologically innovative companies that provide healthcare services. Developing and sustaining the quality of these education programs and ensuring that the level of education they provide matches the job requirements pose challenges.
Looking at the topic globally, Herzlinger in 2013 highlighted the findings on healthcare management education presented at a conference at the Harvard Business School in 2012 (5). At that conference, executives representing several firms belonging to some of the world’s main innovative sectors of health such as biotech, delivery, diagnostics, pharmaceuticals, insurance, hospitals, medical industries, governments, and foundations were interviewed. Participants argued that there is a significant discrepancy between the well-rounded understanding and capacity for innovation required in healthcare management and what the relevant education programs provide (5). These executives emphasized the need for graduates who think innovatively, have excellent problem-solving and change-management skills, and possess more business-related, rather than healthcare-related knowledge, and believed these skills could be obtained more successfully from field studies rather than attending traditional lectures only (5).
Health Services Management Education in Saudi Arabia
Few studies have explored the status and structure of health services management education in Saudi Arabia. Challenges lie in the structure, content, quality, and distribution of programs that offer training in this field. At many universities, faculty members in health management programs belong to various disciplines. In Saudi Arabia, the first health services management programs were established by King Saud University in the 1980s (6). King Saud University used to offer diverse experiences in healthcare management education, with master’s and undergraduate programs linked to different schools. A master’s degree was offered by the College of Business (formerly known as the College of Administrative Sciences), while a bachelor’s degree was offered by the College of Applied Medical Sciences. At present, health services management is taught through six bachelor’s and six postgraduate degree programs across the country (7).
To establish a good foundation for the quality of education, the Saudi government founded the National Commission for Academic Accreditation and Assessment (NCAAA) in 2004, which grants accreditation to academic institutions and programs. Thus, accreditation of educational institutions and programs is not a new concept, and the procedures and requirements for the same have been adjusted over time to obtain the best outcomes. Universities should obtain institutional accreditation from the NCAAA, and most Saudi universities already possess the same. Site visits by external reviewers involved in accrediting institutions and programs play an important role in maintaining acceptable levels of quality. In addition, the quality assessment process requires institutions applying for accreditation to provide documentation, such as the programs’ intended learning outcomes. Learning outcomes are categorized into three main domains; knowledge, skills, and values (8). There is a heavy reliance on written exams in assessment methods. In some courses, written exams account for 80% of the total score. These exams usually focus on the ability to recall information, which may hinder the development of skills associated with learning objectives.
Moreover, education system regulations require students to attend classes on campus, with very few exceptions in the case of online learning. However, during the COVID-19 pandemic, health services management programs have moved to an online mode. Distance-learning methods have evolved as educational platforms with technologically advanced capabilities, including synchronous web-based classrooms. These changes might prompt changes in university education system regulations to allow more flexibility in online learning. In addition, although some health services management programs are offered in Arabic, the main challenge in education is the level of English required. This problem may affect education in different health disciplines throughout the Kingdom.
Additionally, the Saudi Commission for Health Specialties is responsible for registering medical and allied health professionals. After obtaining the licenses, renewal requires several hours of continuous education. The Saudi Commission for Health Specialties faces the challenge of maintaining the quality of continuous education and ensuring that lectures, workshops, and training modules are up-to-date with the changes in the field. The same applies to enabling professionals to develop to cope with such changes.
A Call for Change
The Saudi healthcare system is transforming wherein regulation and monitoring are separated from the provision of services owing to the establishment of a government-holding company consisting of several cooperation clusters. Given this transformation, a crucial question is the extent to which our education system should also change. All areas of education need to periodically revisit the curriculum to ensure consistency of key skills and competencies among graduates. In the area of healthcare, there is limited evidence as to whether existing health services management employees can meet the changing needs of the system.
Changes in the academic field can be challenging, and reaching a consensus on them can be difficult. The available literature on the academic-practitioner gap in health services management in Saudi Arabia and elsewhere is limited. Whether health services management education should continue to be provided at the undergraduate level, or whether it should only be offered at the postgraduate level, remains an open question. This is because the number of unemployed graduates is high. Some commentators have called for providing relevant programs at the postgraduate level to those who have experience in the healthcare market.
Another area of debate is whether this type of program should be offered by public health or business colleges. The new Saudi classification for specialties places the program in the general category of administrative sciences. Cost-cutting may be a factor in deciding whether health services management education will be merged with other specialties to reduce the number of colleges under some universities.
Furthermore, revisiting curricula would help to ensure that they correspond to the dynamic needs of a complex healthcare system. More emphasis should be placed on the analytical components rather than the basic descriptive courses. Ensuring that students have an acceptable level of English can help them achieve this goal. Extensive English teaching is required in primary schools. Compulsory English courses during the preparatory years and summers may also be necessary.
Effective geographic distribution of institutions providing healthcare management programs is essential for the success of the sector. As is the case for other educational fields in the Kingdom, most of the teaching is conducted in the form of didactic lectures. New bridges between academic experts and practitioners may be beneficial for students (9). There is a need for more inquiry-driven learning combined with regular contact with the country’s healthcare facilities (10, 11). This will help students to understand their future jobs. This will also facilitate greater involvement in the practical aspects of the various roles found in different health fields.
Several studies have been conducted in the field of health services management. One priority is to arrive at an in-depth understanding of the demands of employers in different industries. This understanding requires both quantitative and qualitative approaches to examine the skills necessary for relevant job positions. This type of research requires employers to improve their human resource procedures and job descriptions. Currently, there is no publicly available, reliable, or clear documentation for this type of data. Since some of the regional structures are similar to those of national organizations, an analysis of the demands in Saudi Arabia should extend from the national to the regional level. This is essential for gaining an understanding of education in health services management to be prepared to address the major anticipated reforms. In addition, research is needed to help rationalize the development of specialty courses to suit the requirements of the field. Conducting a series of studies on the types and numbers of candidates required in this industry is essential for shaping the structure of health service management education
These studies revealed the need for a review of teaching and assessment methods. A higher degree of consistency across programs and consistent definitions for the base set of competencies for all graduates in the field would be adequate for a range of management positions
The author declares no conflict of interest.
Funding of this article was provided by the Saudi Society for Health Administration.
The sole author is responsible for drafting, writing, sourcing, article screening and final proofreading of the manuscript.