Noura A. Abouammoh

7.4 Implications for policy and practice

Findings from this exploratory study suggest a number of ways to improve the quality of care provided by IMGs to patients in SA, including better patient education as well as better training and support for IMGs.

7.4.1 Dissemination strategy

The proposed dissemination strategy for this research is as follows:-

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  A series of lectures to raise awareness of the findings of the current study, particularly concerning the importance of empowering IMGs and educating patients. It would be useful to conduct the lectures at the Department of Family Medicine at the KKUH in order to gain professionals’ feedback and the chairman’s support. Inviting the Department of Quality Management; and the Deanship of Community Service and Continuing Education at the KKUH to attend these lectures could be important as a strategy to involve them in decision making in regards to resources for training, support and education materials.
  
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  Workshops to design and organize training programmes for IMGs using the findings from the current study, IMGs’ suggestions and the literature on cultural competence training will be organized initially at the department level with the help of the Department of Quality Management at the KKUH. IMGs will be encouraged to be involved in designing the training programmes including suggesting the best time and place to conduct them as well as planning patient education materials. These workshops could additionally include discussions in regards to best persons to conduct cultural competence training programmes. The Deanship of Community Service and Continuing Education will be responsible for providing and distributing information and materials to patients. Distributing booklets and using patient education screens in the waiting areas would help to educate patients about the IMGs’ major role in delivering health care. Implementing these training and education programmes at the hospital level including all the departments might follow.
  
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  The Saudi MOH is keen to improve its health services, striving to get its resources utilized properly. It is open to considering research findings and funding research to achieve this purpose. Highlighting the issues raised in the current study, which can be considered as the key to high quality care at the interpersonal level, is an important element to feed into the MOH current strategy to improve the quality of healthcare, in general, and primary health care, in particular. Findings of the current study will be presented at national conferences concerning quality assurance in health care and patient-physician communication, which are organized by the MOH via the SCHS. Findings will also be submitted for publication to national academic journals as a strategy to share them with the authorized personnel at the Saudi MOH.
  
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  After testing the implementation of training IMGs to be culturally competent, and educating patients on the patient-physician relationships and quality of care at the KKUH, results could then be shared with the MOH for further reinforcement. This could be facilitated by a team from the KKUH, including the researcher, who could approach the authorized personnel at the MOH to share the findings and gain funding.
  
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  Meetings involving the General Administration of Quality and Patient Safety, the Department of Medical Research and Medical Education Department at the MOH could be conducted to plan how, and by whom, these training programmes would be implemented; and which educational materials would best be dispensed to IMGs and patients at the level of PHCCs. Piloting the appropriateness and effectiveness of the training programmes and patients’ education on a number of PHCCs is an important step in ensuring the success of these programmes before national dissemination.
  
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  Funding for training and supporting IMGs and educating patients could be sought from the KKUH, at the hospital level; from the Saudi MOH; or from King Abdulaziz City for Science and Technology (a governmental institution that is administratively responsible for reporting to the Prime Minister and aims to support projects involving policy making, at the national level).
  
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  It is equally relevant to disseminate the findings internationally through academic journals emphasizing the importance of addressing patients’ attitudes toward IMGs, in parallel to IMGs cultural competence training, as a strategy to improve the quality of care. Journals concerning quality in health care, transcultural health and medical education could be appropriately target journals.
  

7.4.2 Patient education and information

Patients could be made more aware of the significant role IMGs play in achieving the MOH’s goal of delivering accessible high quality health care to all people. Educating patients, through media and high-level personnel, such as PHCCs’ managers, Saudi physicians and the health minister, or through distributing booklets about the IMGs’ major role in the MOH’s strategy for delivering a comprehensive and accessible health care for the Saudi population is needed. This may encourage patients to trust IMGs as valuable professional members of the PHCC team and have more confidence in their abilities.

The issue of improving the brochures and booklets handed by IMGs to patients has been raised in this study. More culturally appropriate written materials to help facilitate communication and understanding of the contents is required. Additionally, the MOH could introduce all IMGs to, and involve them in the development of, appropriate brochures and booklets.

7.4.3 IMG training

As with other developed countries, non-Arabic speaking IMGs could go through an Arabic language assessment before they are allowed to work in SA. Alternatively, they could be encouraged to attend language classes in order to facilitate a higher standard level of interaction between them and their patients. As Saudi people speak different dialects, it is not realistic to teach IMGs different dialects; however, teaching traditional Arabic could be more practical, as it is understandable to most Saudi people. Alternatively, interpreting services could be made available to all IMGs who do not speak Arabic as a mother tongue.

For IMGs to be able to meet Saudi patients’ needs and expectations and learn enough about the culture to deliver appropriate care, the MOH could facilitate supportive community integration for IMGs. This could start from the local mosque or the local PHCC, where IMGs listen to patients’ needs. Integrating with local people could be a practical possibility, as each PHCC serves a defined community and could assist in developing an informal relationship between physicians and patients, enabling IMGs to directly learn about the culture, and enabling patients to get to know their IMGs on a more personal level. This may eventually improve both IMGs’ confidence in providing culturally sensitive advice and the general relationship between IMGs and patients.

Empowering newly-arrived IMGs by introducing them to orientation and training programmes focusing on Saudi culture, as well as patients’ needs and expectations, and delivering culturally appropriate advice and communication skills, are fundamental to improve the quality of care provided to local patients. Mentoring system where long standing or Arabic speaking IMGs partner up with new/non-Arabic speaking IMGs to support them informally and provide advice is recommended.

Patients’ trust in IMGs may be increased if they become aware of these training programmes as this kind of initiative may reduce negative, preconceived ideas about IMGs’ knowledge and capability in terms of providing culturally appropriate care.

7.4.4 Support structure

A line of communication should be opened to all IMGs in which they can share complaints without feeling insecure about their work or being judged by others. This would make IMGs less frustrated about confronting patients and focus more on providing care in a healthy environment. A neutral person who is not responsible for evaluating the IMGs’ work could be the right person to receive their complaints and support them in regards to the right way to react to prejudicial attitude from patients. IMGs and all health professionals could benefit from more training on the most effective ways to deal with difficult patients.

Furthermore, training PHCC managers and supervisors to support IMGs and deal appropriately with cases of prejudice is also needed.

Less emphasis by PHCCs’ administrations should be given to the duration of the medical consultation, especially non-Arabic speaking IMGs with less experience. Increasing appointment times, or reducing the number of patients per IMG could achieve this.