Trilogy Concept

Background and Ministry of Health Riot

Ahmad John Saraq was a prominent physician in the late 1960s within Sayaffallah working for the University Medical Center in the capital city when he was tasked with putting together an approval for the Sultan (MHLF) of the country to improve the nations healthcare system and more importantly make it more effective in teaching the practice of medicine to incoming residents and medical personnel and to make it less cost redundant. Healthcare up until this point had been administered by a strict military system that prioritized tenure and number of patients seen resulting in a top heavy organization that prized administration rather than quality of care.

Within society there had also been a series of large nationwide protests following the death of a 6 year old child who passed away after coming down with a routine lung infection after having a bad case of pneumonia. Subsequent medical review found that the child had died of pnuemonia however governmental review results found that the child had died due to negligient care specifically stemming from an inability to treat the child quick enough to reverse the condition. When the results of this government study were leaked to the national media it created an uproar within the nation and resulted in widespread unrest throughout the country with many questioning both the quality of care and also the quotient of compassion from the Sultan and government officials in allowing the healthcare system to deteriorate for so long.

Many additional reports also leaked out showing that the government consistently covered up negligent care and altered the statistics to paint a picture of poor health as a cause of poverty and environmental conditions rather than faulty medical treatment by the physician. As the cases became made public a great public inquiry was demanded of the Parliament and resulted in the Ministry of Health being purged completely of its senior staff and the Minister of Health being held by the judiciary in contempt for his inability to provide complete transparency of existing medical records.

On June 1, 1965 the Ministry of Health was raided by rioting citizens who gained access to the records and archives section of the Ministry and soon made public the past 2500 fatalities in the country many of whom were due to physician related negligence. The raid on the Ministry of Health in June of 1965 was a watershed moment for many within the country and the one individual who demanded change was Ahmad Saraq. Ahmad Saraq personally vowed to treat all patients he encountered completely free of charge and to retain the records of those patients so that they could not be altered by the government in the event of a tragedy. This action by Dr Saraq caught on and soon by July of 1965 over 600 fellow physicians across the country also made the same vow as Dr Saraq.

Commission of 1967

The aftermath of the 1965 riots and later actions by Dr Saraq and the physicians of Sayaffallah created the drive necessary for a parliamentary inquiry to be started which formally began and lasted until 1967 which formally concluded with the formation of a commission on healthcare led by Dr Saraq. Dr Saraq was tasked with finding and implementing broad changes within the healthcare system to not just promote transparency in the patient/physician relationship but to also find ways of ensuring that physicians are held accountable for decisions made in the medical practice and to make sure they were receiving the maximum amount of training possible within their field of medicine.

The Commission of 1967 was put to work immediately and began touring hospitals throughout Sayaffallah in an attempt to gather a broad amount of data to see what current standard practices were across the country and whether there was an uniformity between hospital standards of care. In addition to this counterparts in each level of hospital care were included on the commission so as to create a final report that covered each level of care from basic nurses aides up to registered nurses and even up to the surgical and end of life care. Each counterpart level was tasked with compiling statistical research on their level of care at each of the hospitals within the country.

After the Commission's compiled research was complete they met in a series of weekly sessions in the capital city to go over proposals by both the doctors as well as the nurses. The dialogues that the Commission participated in last for an entire year and involved over 3500 experts from the medical field of practice at all levels of care and over 300 officials from the Ministry of Health who helped to formulate the costs associated with any implemented changes. The Commission finished their work completely by 1969 and Dr Saraq presented the findings of the commission to a joint parliament sessions which then spent over 12 hours of consecutive endless debate on the findings before voting overwhelmingly for the findings to be accepted.

Dr Saraq was then asked by the parliament to come up with his own proposal and in return Dr Saraq asked for one year to do so.

The Trilogy Concept

The Trilogy Concept is the result of that one year Dr Saraq took to formulate his own proposal and it was unanimously accepted by the parliament and voted to be implemented immediately. The Trilogy Concept is a ground breaking piece of work that Dr Saraq called his opus and final work as a physician, after is completion Saraq retired from medicine and was elected into the Prime Ministers position by the Parliament of Sayaffallah.

The Trilogy Concept consists of 3 principles working together for the quality care of the patient

*-Education & Training

• -Critical Review
• -Patient Involvement

Education and Training is the first tier of the Trilogy concept and it means that in each of the hospital 50% of the physician workforce are medical residents and 50% are established senior physicians who are there to mentor and lead the residents and to guide them into success. Residents spend a total of 10 years within a clinical hospital setting after which they are deemed to have completed their residency and they then move to smaller practice either independent or they work out of a smaller regional clinic rather than a hospital. After 10 years in a regional clinic or independent practice with annual excellency rating they are then given the ability to move to a higher paying senior medical position within a hospital setting in which they then are responsible for overseeing patient care and also training new residents into the medical field itself.

The second tier is that of Critical Review, all decisions made by residents are reviewed after they have been made by an on call senior physician or senior registered nurse who then approves it or alters it making changes as necessary for the benefit of the patient. All of these steps are documented and are called "critical review" after a residents shift they enter into a direct one on one review with a senior physician who goes over all successful steps taken and all steps that were altered or edited by a senior member of the medical care team thus providing the resident with the ability to learn and the ability to grow from their daily experience caring for a patient.

The third tier is the final tier and it connects back to all of the tiers. At the end of the day patient involvement is the key to success. By providing the patient with maximum transparency as to the success record of their attending physician the patient is directly involved and able to change their physician at any time should they so choose to do so. Futhermore each hospital facility is required to provide full transparency as to the cause of death for a patient and any government reviews that take place into the cause of death of a patient.

The Trilogy Concept incorporates these 3 features into one and is the basis on which healthcare is built in Sayaffallah.Now the trilogy concept is widely taught in the school setting prior to a students residency and is required knowledge for many nurses and physicians. On a clinical level the trilogy concept has produced a growing trend of medical excellence and has seen a reduction in the overall amount of cost redundancy and lack of transparency. Patients are confident knowing that their level of care is something that they can take ownership in and know fully what to expect at each step along the way.