Erik Koornneef - Profile on Academia.edu (original) (raw)

Papers by Erik Koornneef

Appropriate diagnostic testing to identify persons infected with SARS-COV-2 is a vital part of a ... more Appropriate diagnostic testing to identify persons infected with SARS-COV-2 is a vital part of a health system's ability to control the global pandemic of COVID-19 disease. The primary purpose of this review is to provide an overview of the mass testing strategy implemented throughout the UAE and the overall impact it has made on containing and controlling the spread of the disease. This study describes the mass testing strategy and capacity of the UAE during the pandemic of the new coronavirus SARS-COV-2. The UAE has conducted 15 million polymerase chain reaction (PCR) tests to SARS-COV-2, as of 15 November 2020. The number of tests per day varied from 10,000 by the end of March to 120,000 tests per day in November 2020. The mass testing initiative across the entire UAE forms an integral part of a bigger strategy focusing on testing, tracing contacts and isolating positive cases.

Zenodo (CERN European Organization for Nuclear Research), Mar 30, 2023

Background: Kuwait overall health expenditure, in 2019, was 5.5% from the gross-domestic product ... more Background: Kuwait overall health expenditure, in 2019, was 5.5% from the gross-domestic product and the state is the biggest healthcare provider in secondary and tertiary hospitals. Hospital efficiency and productivity are, therefore, an important issue to analyse, specifically in terms of number of visits to outpatient clinics, the number of surgical procedures performed, bed turnover and bed occupancy. Data envelopment analysis has been used to provide insights in the understanding of this growth in other countries. Methods: Data envelopment analysis (DEA) was used to estimate technical and scale efficiency scores for seventeen public hospitals in Kuwait from 2015 to 2019 using a two-stage DEA. Technical efficiency scores were regressed against institutional characteristics using Tobit regression to investigate the determinants of efficiency differences amongst hospitals. The mean technical efficiency score for all hospitals was 75%, and it improved by 1% since 2015. The mean pure technical efficiency score was 85% in 2015 and improved to 86% in 2019. The mean scale efficiency score was 89% in 2015 and decreased to 88% in 2019. Only five hospitals were constantly technically and scale efficient. Tobit regression showed that hospital efficiency was significantly associated with the hospital level (secondary or tertiary), number of beds, bed occupancy rate and the average length of stay. Conclusions: Most public hospitals in Kuwait were not technically and scale efficient, but improvements were observed in the overall scores and pure technical efficiencies of these hospitals throughout the study. The identification of the factors influencing efficiency is crucial for hospital managers and policymakers to take evidence-based decisions to improve the technical efficiency of the main health-producing units in the country.

The UAE has embarked on an ambitious reform program, Vision 2021 24 , with an overall aim to be r... more The UAE has embarked on an ambitious reform program, Vision 2021 24 , with an overall aim to be ranked globally among the top 20 countries (in 2017 the UAE was ranked 39 th on the Legatum Prosperity Index 25 ). Vision 2021 also outlines the performance improvement targets for all aspects of health care: service provision, population health, public health and healthcare regulation. The current healthcare regulatory landscape in the UAE is quite fragmented with a number of different healthcare regulatory authorities responsible for their own area 26 . There have been calls for a more 'nuanced' regulatory approach to address this fragmentation 23 and create an environment that is more conducive to competition and private sector growth. A number of educational, research and regulatory organizations in the UAE participated in this research, including the largest and highest ranked university in the UAE (UAE University), the Abu Dhabi healthcare regulatory authority and the Behavioural Economics Department within the New York University Abu Dhabi. Throughout the period of this PhD study (2010-2019), I combined these research activities with full time leadership roles with a number of healthcare regulators and oversight agencies in the UAE, including the Health Authority Abu Dhabi (now known as the Department of Health) and the Ministry of Presidential Affairs. This study aims to contribute to a better understanding of healthcare regulation by taking an in-depth look at three different regulatory methods used to regulate the conduct and performance of healthcare professionals and organizations in the Emirate of Abu Dhabi and the UAE. In this Chapter I will delve into the role, objectives and methods of regulation in the healthcare sector, as well as describe its anticipated benefits and highlight some of its unintended consequences. At the end of the Chapter I will also outline the focus of this thesis and describe the methodology for the study. Chapter 1 18 Effectiveness can be defined as 'the degree to which the objectives of a program, care, services, or system are achieved' 43 . In this section we will use Freiberg's taxonomy 37 to review the existing empirical evidence that describes the effects of healthcare regulation. Governments may seek to create, oversee or influence markets by limiting or preventing access to a market or liberalization of a monopoly or duopoly. Other ways to influence a market can be by imposing taxes, charges or levies. The main reasons to deploy these method are to create efficiencies, improve access to healthcare and establish financial accountability 44 . For example, the recent expansion of health insurance coverage under the Affordable Care Act in the United States has resulted in a significant increase in insurance coverage and utilization 45,46 . Economic regulation has been criticized as a crude and largely ineffective mechanism in the healthcare sector 47 , delivering negligible benefits 48 . When it comes to healthcare regulation the focus has often been on so-called social regulation 44 that aims to change the behaviour and performance of organizations and professionals, rather than economic regulation. Transactional regulation consists of oversight arrangement through contractual and purchasing agreements, as well as grants, between government agencies and third parties 37 . These regulatory arrangements may include stipulations and requirements for the third party, for example compliance with privacy requirements, minimum wages for staff or the contractual agreement may stipulate that the third party achieve quality accreditation. These terms and conditions can be applied to ensure efficiency gains through competition and create greater accountability. In healthcare regulation, transactional methods include rate setting 35 . There is some evidence that rate setting can be used as an effective mechanism to contain expenditure and constrain expenditure growth 35 . The effects of one specific form of authorization, accreditation, has been the focus of an increasing number of studies across the world 49 . Most studies have found limited empirical evidence in support of the widespread use of accreditation as an effective strategy for improving performance in healthcare 50 . In the US for example, researchers compared medication errors between hospitals accredited by the Joint Commission International (JCI) and non-accredited hospitals and found no statistically significant differences 51 . A randomized controlled trials in South Africa 52 found no significant effect on performance of accredited hospitals compared to the control group. However, in Denmark researchers found an associa-Chapter 1 20 An effective way to improve quality and contain costs are patient registries that track and make available the outcomes various population groups 68 . A large study comparing 13 registries in 5 countries concluded that registries can improve patient outcomes at a lower costs 69 . In the Netherlands, the establishment and maintenance of a national colorectal cancer surgery registry resulted in a 29% decline in mortality and 20% decline in severe complications 70 . Another informational regulatory tool is to disclose and release information such as reports about the quality of care. Food or menu labelling, for example, can help to reduce overall calorie intake. A large systematic review also concluded that the public release of performance data helps to stimulate change and improve quality. 72 Finally, regulators can also use less prescriptive and directive tools and more persuasive tools 38 , such as information campaigns and training. As Gunningham points out 73 , one of the most powerful tools for any regulator is acquiring and expanding its credibility and legitimacy. Ayres and Braithwaite's concept of responsive regulation 38 can assist regulators in finding the right regulatory strategy with the highest likelihood of success 74 . For example, many patients do not adhere to medical recommendations, resulting in lower than expected patient outcomes. 75 However, when patients are more likely to accept a clinician's recommendation if patients perceive that the clinician is credible and uses fair procedures 76 . Applying this understanding in the regulatory context may also result in greater compliance with regulatory requirements. Methods of legal regulation include laws, guidelines and rules. Growing evidence exists indicating that Clinical Practice Guidelines (CPGs) can, at times, have positive effects on the quality of clinical care 77 . Clinical Practice Guidelines are often used to support clinicians in using best available clinical evidence in their daily clinical practice. There is some evidence that by standardizing clinical practice improvements in the quality and safety of care can be made 78,79 . Since the positive effects are widely acknowledged, health care regulatory agencies have often mandated the development and implementation of guidelines 80 . Another form of applying regulatory requirements is through mandatory incident and adverse event reporting 81 . Several longitudinal 82 studies reviewing adverse event rates over a period of time found limited evidence that these mandatory systems resulted in a reduction in incidents or adverse events 83 . Finally, many healthcare regulators have attempted to steer the behaviours of organizations and professionals by setting standards describing and specifying the compliance require-Validity and Reliability of Inspector Assessments of Acute Hospitals in England.; 2014. http:// www.kingsfund.org.uk/events/european-health-policy-group-autumn-2014-meeting. 60. Tuijn SM, Robben PBM, Janssens FJG, van den Bergh H. Evaluating instruments for regulation of health care in the Netherlands.

Health and Wellness Characteristics of Employees Enrolled in a Workplace Wellness Study in the United Arab Emirates: A Descriptive Analysis of a Pilot Study

Curēus, Jun 13, 2024

Frontiers in Public Health, May 12, 2021

BMC Health Services Research, Sep 20, 2017

Background: The United Arab Emirates (UAE) government aspires to build a world class health syste... more Background: The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. In this paper we review the progress and outcomes of health systems reform in the UAE. Methods: We searched relevant databases and other sources to identify published and unpublished studies and other data available between 01 January 2002 and 31 March 2016. Eligible studies were appraised and data were descriptively and narratively synthesized. Results: Seventeen studies were included covering the following themes: the UAE health system, population health, the burden of disease, healthcare financing, healthcare workforce and the impact of reforms. Few, if any, studies prospectively set out to define and measure outcomes. A central part of the reforms has been the introduction of mandatory private health insurance, the development of the private sector and the separation of planning and regulatory responsibilities from provider functions. The review confirmed the commitment of the UAE to build a world class health system but amongst researchers and commentators opinion is divided on whether the reforms have been successful although patient satisfaction with services appears high and there are some positive indications including increasing coverage of hospital accreditation. The UAE has a rapidly growing population with a unique age and sex distribution, there have been notable successes in improving child and maternal mortality and extending life expectancy but there are high levels of chronic diseases. The relevance of the reforms for public health and their impact on the determinants of chronic diseases have been questioned. Conclusions: From the existing research literature it is not possible to conclude whether UAE health system reforms are working. We recommend that research should continue in this area but that research questions should be more clearly defined, focusing whenever possible on outcomes rather than processes.

BMC Medical Education, Dec 1, 2018

Background: Although healthcare regulation is commonplace, there is limited evidence of its impac... more Background: Although healthcare regulation is commonplace, there is limited evidence of its impact. Making sure that healthcare professionals comply with the regulatory requirements is a prerequisite to achieving effective regulation. Therefore, investigating factors that influence compliance may provide better insights into how regulators can be more effective. This study aimed to find out if medical students' perceptions of regulation in the United Arab Emirates are associated with self-reported regulatory compliance. Methods: In the cross-sectional study, we administered a structured questionnaire to students of medicine with different statements concerning their perceptions of healthcare regulation and self-reported compliance. The statements included statement regarding the legitimacy, fairness and regulatory performance, as well as the risk to getting caught and being punished. The association between perceptions and self-reported compliance was analyzed using multiple regression models. Results: One hundred and six Year 3 and 4 pre-clinical medicine students (56.4% response rate) completed the survey. Almost 40% of the students rated their level of awareness and understanding of regulation as Good or Very Good., despite their lack of direct contact with the regulatory authorities (less than 10% reported monthly or more frequent contact). Self-reported compliance was high with almost 85% of the students either agreeing or strongly agreeing with the four compliance statements (mean score 4.1 out of 5). The findings suggest that positive perceptions of the regulator's performance (β 0.27; 95% CI 0.13-0.41), fairness of the regulatory processes (β 0.25; 95% CI 0.11-0.38) and its legitimacy (β 0.23; 95% CI 0.05-0.41), are stronger associated with compliance than the perceived risks of getting caught and being punished (β 0.10; 95% CI -0.04 -0.23). Conclusions: To improve compliant behavior, healthcare regulators should pay more attention to their own perceived performance, as well as the perceived fairness and legitimacy of their regulatory processes rather than focusing on more traditional methods of deterrence, such as perceived risk of getting caught and being published.

MedEdPublish, Aug 22, 2018

This article was migrated. The article was not marked as recommended. Competency-based education ... more This article was migrated. The article was not marked as recommended. Competency-based education and training has become a key component of healthcare systems across the globe. Ensuring that healthcare professionals are able to assess their own competencies is critical for continued professional development and the delivery of high-quality care. The aim of this study was to assess how medical students perceive their performance on an objective structured clinical examination. Using a cross-sectional study design, a sample of Emirati third and fourth year (preclinical) medical students (N=106; 56.4% response rate) was recruited from the United Arab Emirates University in Al Ain, United Arab Emirates. Medical students completed a short non-invasive clinical task (i.e. measuring and recording blood pressure and performing hand hygiene) followed by a structured survey to self-assess their performance and skills. Trained assessors used a clinical skills observation checklist tool to score each student's performance. According to the observed performance, 27.36% of medical students performed the objective structured clinical task adequately. In contrast, 69.52% rated their own performance as adequate. Furthermore, only 8.43% of medical students rated their own clinical skills as below average. This study did not find evidence that medical students can accurately assess their own clinical skills Open Peer Review Migrated Content "Migrated Content" refers to articles submitted to and published in the publication before moving to the current platform. These articles are static and cannot be updated.

Introduction: Modifiable health behaviors have the power to increase (or decrease) the risk of ch... more Introduction: Modifiable health behaviors have the power to increase (or decrease) the risk of chronic diseases, impacting a population’s health and life span. Health and wellness programs can potentially play a major role in initiating and supporting positive changes in health behaviors, which may lead to improving an individual’s health span and reducing the risk of premature mortality. A better understanding of the health and well-being status of the population is crucial to the design of proper and effective interventions. This study aimed to describe the health and well-being status of a cohort of 123 employees in the United Arab Emirates. Methods and analysis: This study reports the demographic characteristics, body composition, cardiovascular fitness, functional fitness, biological age, and well-being of 123 employees from a large health sector company enrolled in a workplace wellness study in the United Arab Emirates. Employees were invited to participate in an intervention ...

Picture of the wash basin in the private examination room featuring the watching eyes

Picture of the wash basin in the private examination room featuring the watching eyes.&l... more Picture of the wash basin in the private examination room featuring the watching eyes.</p

Measuring quality in services for children with an intellectual disability

International Journal of Health Care Quality Assurance, Aug 1, 2006

PurposeTo evaluate the application of one particular quality measurement tool, the SERVQUAL instr... more PurposeTo evaluate the application of one particular quality measurement tool, the SERVQUAL instrument, as a potential mechanism to measure quality in services for children with disabilitiesDesign/methodology/approachStaff and family of children with an intellectual disability in two organisations providing specialist therapy and day completed an adapted SERVQUAL questionnaire. A total of 81 SERVQUAL questionnaires were distributed and 59 questionnaires were returned (response rate of 73 per cent).FindingsThe SERVQUAL instrument can be considered as a useful diagnostic tool to identify particular strengths and areas for improvement in services for people with disabilities as the instrument lends itself for the monitoring of the effectiveness of quality improvement initiatives over time. The findings also showed relatively high customer expectations and the organisations involved in this research are currently not meeting all of these high expectations as significant quality gaps were found in the areas of reliability and responsiveness.Research limitations/implicationsThe sample size was relatively small and the measurement of quality using the SERVQUAL instrument remains a challenge, due to the conceptual and empirical difficulties.Practical implicationsThe SERVQUAL instrument is probably most be attractive to service managers and funding organisations because of its ability to identify gaps in the quality of the service.Originality/valueThe tool had been used to measure quality in services for people with disabilities and the research has shown that this tool might be an important additional quality measurement tool for services.

Average quality of hand coverage across treatments (with 95-percent confidence intervals)

Average quality of hand coverage across treatments (with 95-percent confidence intervals... more Average quality of hand coverage across treatments (with 95-percent confidence intervals).</p

Efficiency evaluation of public hospitals in Kuwait: an application of data envelopment analysis

Average compliance with turning-off-tap-with-paper-towel rule across treatments (with 95-percent confidence intervals)

Average compliance with turning-off-tap-with-paper-towel rule across treatments (with 95... more Average compliance with turning-off-tap-with-paper-towel rule across treatments (with 95-percent confidence intervals).</p

Average time spent washing hands across treatments (with 95-percent confidence intervals)

Average time spent washing hands across treatments (with 95-percent confidence intervals... more Average time spent washing hands across treatments (with 95-percent confidence intervals).</p

Journal of Evaluation in Clinical Practice

Our aim was to examine and describe the current situation in Gulf Cooperation Council (GCC) membe... more Our aim was to examine and describe the current situation in Gulf Cooperation Council (GCC) member countries regarding the development, implementation and evaluation of clinical practice guidelines (CPG). The objectives were to describe from where the studies originated, what the clinical focus was of each study and examine the methodology and the status of each study (i.e. development, dissemination, implementation and evaluation). Review of literature - two stages: stage 1: screening through an abstract review, followed by independent adjudicator; stage 2: detailed assessment and classification. Considering the widespread acceptance that CPG's are useful and effective tools for quality improvement in health care, it is worth noting that relatively few studies have been conducted in the GCC region that examine CPG. Furthermore, the reviewers found that the quality of the research methods used could be improved. The majority of the studies that were conducted evaluated the effec...

Additional file 1: of Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review

Table. Insurance costs, Abu Dhabi, 2011â 2014 (DOCX 15Â kb)

Additional file 1: of A cross-sectional study into medical studentsâ perceptions of healthcare regulation and self-reported compliance: a study conducted in the City of Al Ain, United Arab Emirates, 2016

Survey Instrument. (DOCX 24 kb)

Introduction Long-term care (LTC) is delivered to persons that can no longer perform daily tasks ... more Introduction Long-term care (LTC) is delivered to persons that can no longer perform daily tasks (1) due to injury, chronic illness, the ageing process, or disability (2). Al-Kandari and Crews (3) point out that LTC entails supervision and guidance to persons that cannot make informed decisions due to cognitive impairments such as identity confusion, dementia, and Alzheimer disease. Therefore, LTC is not only limited to the elderly and ageing persons but can also include children, teenagers (4), and persons from different age groups (5). According to the World Health Organization (WHO), there are over 9.5 million persons that are admitted to skilled nursing facilities or reside in nursing homes across the globe. In the United States, about 3.2 million persons are admitted to LTC facilities annually while in Europe the number of individuals seeking LTC services ranges from 2.7 million to 3.3 million (6,7). The commonly reported chronic and life-threatening conditions for all ages inc...

International Journal of Environmental Research and Public Health, 2021

The study aim was to understand the availability of personal protective equipment (PPE) and the l... more The study aim was to understand the availability of personal protective equipment (PPE) and the levels of anxiety, depression, and burnout of healthcare workers (HCWs) in the United Arab Emirates (UAE). This study was an online-based, cross-sectional survey during July and August 2020. Participants were eligible from the entire country, and 1290 agreed to participate. The majority of HCWs were females aged 30–39 years old, working as nurses, and 80% considered PPE to be available. Twelve percent of respondents tested positive for SARS-CoV-2. Half of HCWs considered themselves physically tired (52.2%), reported musculoskeletal pain or discomfort (54.2%), and perceived moderate-to-high levels of burnout on at least one of three burnout domains (52.8%). A quarter of HCWs reported anxiety (26.3%) or depression (28.1%). HCWs reporting not having musculoskeletal pain, having performed physical activity, and higher scores of available PPE reported lower scores of anxiety, depression, and b...