BackInterview of the General Director of the OLYMP CDL branches Suleimenov Y.M. to the Ulagatty Meditsina magazine
ULAGATTY MEDITSINA
4 (6) AUGUST–SEPTEMBER 2014
Text: Madina Nurgaliyeva
The independent clinical diagnostic laboratory "Olymp" was the first in Kazakhstan to be internationally accredited according to the requirements of the International Association of Accredited Laboratories, thereby raising the overall standard of quality of services in the industry. We are talking about this and many other things with Yerlan Suleimenov, General Director of OLYMP CDL.
- This year, the Salamatty Kazakhstan program for 2010-2014 ends. What are your assessments of the implementation of this program?
- This year, as part of the implementation of the state program "Salamatty Kazakhstan" for 2010-2014, there have been no significant changes that would affect the development of the private healthcare sector at the systemic level. Rather, we are talking about individual implemented measures. For example, private hemodialysis centers, a centralized OLYMP laboratory in Qaragandy, etc. have been opened. In the future, we expect the continuation of the consistent policy of the Ministry of Health without any surprises, without sudden changes in the tariff retroactively.
- How do you feel about the idea of transferring screening programs to private players with networks through the republic? For example, tuberculosis, etc.?
- Regarding tuberculosis, I will say that, most likely, private players will not be allowed to participate in this process, because the problem of tuberculosis is very relevant, and today it is very seriously controlled at the state level. In addition, there are still international players, the DOTS program has been introduced, so the situation is special in terms of tuberculosis screening. As for cancer screening, all kinds of hepatitis or other screenings, another option is possible here. But the public sector is not yet ready and cannot fully work at the national level, and among private players there are only a couple of those who can actually do this and fully provide these services on the scale of the republic. In my opinion, a systematic measure would be the introduction of ratings of heads of medical departments in the regions. Now more and more powers are being transferred to the regional level, so it would be logical to transfer responsibility to them. This rating should be created based on the achievement of the goals of the state program for the development of medicine, and specifically private healthcare: the development of PPP, the involvement of private players in the implementation of government orders, etc. Test can be made on the outcome of the current program and the new phase for the next 5 years. The fact is that in some regions, the heads of healthcare departments have taken a tough position, preventing the private sector from developing. The head doctors are afraid to work with us for the simple reason that the first head simply "cuts" and restricts the private sector. This can be easily monitored by the list of subcontractors, which shows how much the private sector is present in the process under discussion. This is a serious problem that contradicts the policy of the President of the country on the development of the private sector in healthcare.
- You represent a large domestic company in the medical sector. How do you feel about public-private partnership (PPP) in medicine?
- I have a positive attitude, but to be honest, we are not trying to integrate ourselves into this process. Much is not spelled out in the legislation, there are no specific rules by which it would be possible to work. And you can work successfully only when there are clearly defined rules. It is important for any investor or private sector to participate in PPP, but until the healthcare policy itself is clearly spelled out, I think it is not advisable. Here is one illustrative example: the April tariff changes without the approval of entrepreneurs, in my opinion, are not completely legitimate, because they were not justified by calculations and were not coordinated even with the National Chamber of Entrepreneurs, i.e. the price/tariff policy is not stable. And this entails high risks, although the PPP states that tariffs cannot change. Hence the reserved attitude towards such projects. It should also be taken into account that the medical business is a tidbit not only for private individuals, but also for state officials who see themselves as managers in the future. Therefore, there is a very tough competition here, even for current head doctors who know their medical institution well. I believe that it is difficult for a private citizen who is not in the general healthcare system to get involved in a project related to the privatization of medical institutions, especially in connection with PPP. It is not for nothing that they say that good officials are great businessmen. So we, with our experience in our medicine, our branches across the country, partners who would like to participate in this process, we are not going into a PPP to run some public hospital.
- How do you assess the results of this year for the market of independent clinical diagnostic laboratories in the Republic of Kazakhstan?
- The market is growing in all directions. For example, a large Kazakh company GEM merged with the Russian INVITRO, Azerbaijani investors entered our market with AQUALAB,etc. Kazakhstani companies have begun to actively enter foreign markets. Small urban laboratories are developing rapidly, they have begun to position themselves more clearly in the market, expand and compete more boldly. At the same time, there is a qualitative development of the market – in depth. For example, our company alone has implemented over 20 new highly informative laboratory tests aimed at diagnosing liver pathology, rare infectious diseases, autoimmune processes, oncopathology and allergies.
- How would you characterize this year for your company?
- We are in a trend – we are developing in all directions. As noted above, we are expanding our product line through highly informative and unique tests for our country. We increased the number of outlets in the country by about half, concluded direct contracts for the purchase of reagents from European manufacturers (which allowed us to reduce the cost of reagents by about 20% and more easily "bear" the devaluation of the tenge and the reduction of prices for public procurement), we are entering the Russian market (Omsk). c.), etc. However, the most important thing that we have focused on this year is the qualitative development of the company, bringing business processes to an international level. In 2014, our laboratory passed the international accreditation according to ISO 15189:2012 "Medical laboratories. Specific requirements for quality and competence". I consider this a great achievement both for the clients and partners of Olymp CDL and for our staff. Now the results of our analysis are recognized in any clinic in the world, which is guaranteed by the presence of the ILAC-MRA mark on the result form (ILAC is the International Association of Accredited Laboratories). In conditions when our compatriots are not seldom treated abroad, it is convenient and saves time and money. In addition, it is the completion of a whole stage of organizational development of the company several years long. At the initial stage, we took training courses and began to implement this standard with the help of specialists. Then we attracted a specialist from Lithuania - Ms. Gorina, we concluded a contract with her regarding the preliminary assessment of our laboratory. She audited us according to the 15189 standard in two laboratories - in Astana and Qaragandy. More than 80 inconsistencies were identified, most of which are minor and insignificant, but there were also several critical ones that we fixed. When in 2012 we were ready to be certified according to the 2008 version, the updated 2012 standard was released, which required significant changes.
- What are the differences between the 2007 and 2012 versions? How significant are they?
- Perhaps the key thing is that the main emphasis is on improving quality standards, high requirements for working with patients, and a focus on ensuring that any procedures that we have in the laboratory are transparent and easily verifiable at every stage. In 2012, these standards were revised in the direction of tightening. They needed to be strengthened to include recording the time of biomaterial sampling as mandatory. Accordingly, from that moment on, it was necessary to record the time of delivery to the laboratory, which should not be violated. We have standards where the delivery time should be 4 hours from the moment the biomaterial is sampled until it arrives at the laboratory. It is important to see this process at every stage, for each client, for each sampling. Everything is recorded - which nurse did the sampling, how it happened, the time of arrival at the laboratory. It has taken some expense and effort to achieve these requirements, ranging from developing laboratory information system software to increasing the number of laboratories, material sampling points, etc. These moments are not visible, they happen inside and are unnoticeable to the average person, but they are achieved by significant efforts of the staff. Another important factor to consider. We have our own region of the world, our own diet – somewhere they eat more meat, somewhere they eat flour, etc. All this affects the norms that should be monitored and special standards should be made for the results of tests that are applicable specifically for Kazakhstan. You have to have good laboratories to do that. For example, liver tests. There are people who are not ill, they are fine. When a certain number of these healthy people and their indicators according to the results of the tests are collected, a norm - our, Kazakhstan's norm - is drawn up. Today we use materials from European manufacturers, and they recommend these standards to us. But they always have a caveat that you have to get your own values in your locality that you have to implement and use. We don't have that yet. But if we make joint efforts, it would be good to implement this in the future. I think we can also help in this, participate in this process in order to get and create our own standards. Another change is related to our measuring instruments – these are scales, dispensers, etc., and they need to be checked in special calibration laboratories that have been accredited by the ILAC branches (International Laboratory Accreditation Cooperation). There is not a single testing laboratory in our country that could ensure compliance with the ILAC requirement for the level of traceability of measuring instruments. Therefore, we were forced to check our equipment in another country, and this is time and additional costs.
- Which technical or human issues were more difficult to solve in the process of preparing for accreditation?
- Strangely enough, everything turned out to be smoother on the technical side, as we had been preparing for this for a long time and our task was to move to this level from the very beginning. Our main goal is high quality, i.e. we immediately set ourselves and solved these issues. We have a special laboratory product – the laboratory information system (LIS), and this allows us to properly build the technological process, i.e. all stages in laboratories, in treatment rooms are marked and lined up, everyone knows what to do and how to do it. As for the human factor, this is, from my point of view, the most difficult moment. The job of preparing staff for accreditation is a difficult one, as people do not know what it is, have no understanding or idea of the standards that exist and what is required of them. We had to put a lot of effort into preparing them. And now we have reviewed their motivation, included additional payment to our employees for support in the preparation of ISO, for its specific application, so that they keep it in working order and constantly use it. If something happens for some reason, they will lose this motivation. Overall, if we had any medical staff in our country understand what accreditation is and follow all the procedures, we would be world champions.
- Was the "candle game" worth the implementation of ISO 15189?
- Absolutely, yes. First and foremost for us is increased responsibility and control. For example, each accredited test requires a monthly external quality assessment, a daily internal one, which we regulated, and there are costs associated with improving logistics, tightening delivery times, etc. But on the one hand, we had significant costs for the quality of services before, and on the other, competition is growing, and if we want to remain market leaders, we need to be one step ahead of our competitors. And, of course, such an important aspect as the impact on industry standards. Due to the fact that we started to implement this standard, many private and public laboratories, especially in Astana, are now forced to pull up to our level with international accreditation. I think this is right: there should be a special reference laboratory to look up to. The game is worth the candle!
- How did you choose a company for accreditation?
- We had two criteria. The first is for the company to be on the official list on the ILAC website and have experience in conducting accreditation not only in Europe. The second, no less important, is for the auditors to be fluent in Russian, so that we understand each other as clearly as possible and can make the most of their knowledge and experience. According to these two criteria, the Slovak People's Accreditation Service, which has more than 20 years of experience, turned out to be the most suitable.
- Has accreditation affected the operation of biomaterial sampling points?
- Of course, in particular time fixing, improving the quality of service, etc. In addition, in general, we have designated 2014 as the "Year of High Service". Among other things, this included the introduction of a new format of biomaterial sampling points – "Mega-treatment rooms". The "Mega-treatment room" is a high–service cabinet that allows using special technology to serve a large number of people (up to 200 people) in a short time. This is an electronic queue, order, and the absence of a nervous environment. Why is this necessary? We see from our clients that often when taking some tests, a person doesn't want others to hear about it. To make customers feel comfortable, we introduce new technologies and service standards. So far we are practicing them in Astana and Qaragandy, and then we will replicate the positive experience.
- What are your plans for next year?
- There are quite a lot of plans. To date, we have accredited the laboratory only in Astana. According to the plan, there are 5 more laboratories ahead that will have to be accredited. We have a special department that monitors these processes, develops special standards, prescribes procedures, because each laboratory has its own technological features (equipment, purpose, etc.), i.e. procedures differ. With these requirements in mind, it is important to analyze them correctly and determine if any changes are required, or if everything can be left as it is. Then prescribe them. Here, of course, we will widely involve employees of the laboratory in Astana, which has already passed accreditation, in order to replicate their experience and knowledge among other laboratories. In general, we want to switch to the 15189 standard in all our laboratories, and we have them in all regional centers. Next year will tentatively be either a year of High Effectiveness or Progress. This is currently being discussed. The question is to make everything transparent, which means to minimize your expenses and bring them to optimal figures. We have already started this process by concluding direct contracts with manufacturers of equipment and reagents (SIEMENS, ROCHE), eliminating intermediaries and reducing costs. Another direction is customer service. For example, we joined forces with one of the educational institutions, concluding an agreement with them on the training of medical equipment engineers. We gave them analyzers so that they could learn how to work and repair it. Moreover, these are not just old faulty analyzers, but quite working equipment on which you can perform tests and learn how to disassemble and assemble them. We will select the best graduates and invite them to our service center, which operates through Kazakhstan. There are quite a lot of reserves here, and we intend to work on them. Of course, we will expand the product line due to new tests for our country (molecular genetic analysis, etc.). We will explore the Russian market, etc.
The main thing is to work and move forward!
ULAGATTY MEDITSINE
4 (6) AUGUST–SEPTEMBER 2014
Text: Madina Nurgaliyeva
