Mohammed Al-Areefi

Between the Indicator and the Patient: A Message from the Field to the Leadership of Health Transformation

July 19, 2026 - 00:00 | Last updated July 19, 2026 - 00:00

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Health development in the Kingdom is no longer a slogan but a reality felt by both patient and doctor. In just a few years, in line with Saudi Vision 2030, we moved from a ministry operating hospitals itself to a modern system separating regulation from operation. The Ministry of Health became a regulator and overseer, while the Health Holding Company —established on June 2, 2022, under Cabinet Resolution No. 469— took over care delivery through twenty health clusters covering the Kingdom's regions. These are not paper changes; life expectancy rose from 74 years in 2016 to over 79 today, a number that cannot be bought with money but is built through work, planning, and patience. We have felt the change in ease of appointments, expansion of digital care and virtual health, and bringing services closer to patients in areas that were previously deprived. This is a national achievement that we should be proud of and acknowledge before making any comments.

At the heart of this transformation is one unchanging and unchangeable goal: the patient. The patient with the highest possible efficiency, real quality, and tangible productivity, not just on screens. Every system we build, every indicator we measure, every performance dashboard we light up green is fundamentally meant to serve that person lying in bed, not the report filed about them. When we lose this compass, problems begin no matter how shiny the numbers appear.

Because what is not measured is not managed, performance measurement has become a cornerstone of our system, to the extent that the Holding Company launched a specialized platform to monitor the performance of clusters and their hospitals in real time. In my specialty, intensive care medicine, indicators are numerous and diverse: risk-adjusted mortality rates, average length of stay, days on mechanical ventilation, rates of ventilator-associated pneumonia, central line-associated bloodstream infections, readmission rate to ICU within 48 hours, and bed occupancy and turnover rates. These are valuable indicators when deeply understood, but dangerous when misinterpreted and treated as mere numbers.

Here is the crux. Some of these indicators are misinterpreted, and some hospital administrations overemphasize them until the means become the end. When a department is asked to reduce 'length of stay' without considering case severity, or to improve 'occupancy' without understanding the nature of the ICU that receives the most complex patients, the entire burden falls on those at the frontline: the doctor and nurse who spend extra hours on documentation that serves the indicator rather than the patient, chasing an empty field in the system more than they chase improvement in a patient's condition. This is a grave mistake; a number taken out of context is unjust to those who produce it and does not serve those it is supposed to serve.

Let me give an example from our daily reality: a patient in the ICU needs one extra day to stabilize their breathing, but pressure on 'length of stay' may push for early discharge to a lower-acuity ward, leading to deterioration within hours and return with a more severe condition, higher cost, and greater suffering for the family. Here, we have served neither the indicator nor the patient; we have deceived ourselves twice: once when we beautified the number, and once when we thought we reduced cost.

Let me say it clearly and unequivocally: we can —if we wish— beautify every indicator on the screen without the patient feeling any difference. We can discharge patients early to improve 'length of stay' only for them to return two days later in worse condition. We can reclassify cases to make our numbers look better. The performance dashboard will light up green, management will applaud, and only the patient will know the truth. When the indicator becomes a goal in itself, it loses its value as an indicator — a rule known to everyone who has worked in management before doctors ever knew it.

Hence, I direct a sincere and respectful message to decision-makers in the Ministry of Health and the Health Holding Company: We are with you in the goal, we believe in the transformation, and we are proud of what has been achieved, but we ask for balance. Balance between achieving the indicator and caring for those who produce it with their own hands. This balance is not a slogan to be raised, but practical steps that can start today:

First: Choose real outcome indicators —such as risk-adjusted mortality and patient-reported experience— not the easy indicators that can be beautified and circumvented.

Second: Adjust every indicator for case severity so that the department receiving the hardest cases is not penalized while the one selecting easier cases is rewarded.

Third: Pair every performance indicator with a staff well-being indicator: nurse-to-patient ratios, working hours, and burnout rates; a green dashboard over an exhausted team is not truly green.

Fourth: Reduce the burden of manual documentation through the digital systems we own and are proud of, so that data is captured automatically instead of weighing down those at the frontline.

Fifth: Involve field doctors in selecting and interpreting indicators, and make them a tool for learning and improvement, not a tool for accountability and intimidation.

Sixth: Establish a culture of safe reporting; a department that admits its mistakes to learn from them is more beneficial than one that hides them to maintain its indicator color, and should be rewarded for its honesty, not punished.

The patient is the beginning and the end, the only indicator that cannot be beautified or deceived. So let us measure what truly matters to him, and at the same time protect those who stand by his side in the most difficult and darkest moments. When the patient is at ease and the doctor is reassured, then all numbers have told the truth, and the transformation has achieved its true purpose. Anything less is just green indicators on a screen, with the patient absent from the equation.