According to the World Health Organization (WHO), and theInternational Diabetes Federation (IDF), the level of diabetes in
the State of Kuwait has reached an “epidemic level” affecting 26
per cent of the population. 
Such figures are alarming to the state of Kuwait’s population and
have a dire impact on the economics of the country. The cost of medical care alone will account for a large portion of the bill, butthe productivity of the citizen will be lowered due to the variouscomplications that people are affected with at younger ages withthe lifestyle.
SERVICE IMPROVEMENT IN HEALTHCARE
Tackling the rising growth of diabetes and its complications mayrequire responses on a number of parallel tracks. It is not enoughto provide medicines and a physician on demand to all. For a lotof people with Type 2 diabetes, the disease is managed throughlifestyle changes and with regular medication and monitoring thatdoes not need expensive medical consultation.Kuwait is fortunate enough to have a comprehensive healthsystem, where care is delivered (essentially) free at the point of care, provided by the Ministry of Health . There is a standardcivil identity system  that doubles as a single patient identifierand more or less systematic record keeping. Existing databases arenot connected and data sharing is limited.For a wealthy country, it can be hard to see why one cannot
simply provide the “best doctors” to those who need them. It is
not just doctors that are needed but rather the most effectivepartnership between the patient, their family and a team of healthcare professionals including, but not relying on, specialistphysicians.Analytic approaches of how to improve health care provision inchronic conditions is problematic given the
nature of diabetes and its complications. Diabetes and cardiovasculardiseases can be seen to emerge from metabolic syndrome, whichis diagnosed using at least 5 factors . As a diabetic patient, onemay have to monitor and manage those 5 factors (and more,depending on complications). Changing one may affect the others,but this may be in a non-linear way.Designing the optimal healthcare response to diabetes and itscomplications, one might ask a number of questions, including:
Who should take a blood pressure - doctor or nurse?
Who should run a blood test - special lab or primarycare lab?
Who should decide whether a blood test should be run -doctor, nurse, patient, algorithm?
How often should a patient be seen - on demand, onschedule?
What situations require specialist and not generalpractice attention: Hospital or Primary Care?
What combination of drugs should diabetic patientstake, and which combinations conflict?
Who is at greatest risk or need of medical support?In responding to the rise of diabetes, we are not designing thesystem, we have to think in terms of change, improvement and themanagement of this change and improvement. Experience inindustry shows that large organizations can achieve change butonly through a conscious use of the tools of prioritization,measurement and participation.The Institute of Medicine set out priorities for a safer, moreeffective healthcare system in 2001 , in a model that can beextended to Kuwait. The core needs of the healthcare systemshould be:
Figure 2: IOM Principles for healthcare improvement
: avoiding injuries to patients from the care that isintended to help them.
: providing services based on scientificknowledge to all who could benefit, and refraining fromproviding services to those not likely to benefit.
: providing care that is respectful of and responsive to individual patient preferences, needs,and values, and ensuring that patient values guide allclinical decisions.
: reducing waits and sometimes-harmful delaysfor both those who receive and those who give care.
: avoiding waste, including waste of equipment, supplies, ideas, and energy.
: providing care that does not vary in qualitybecause of personal characteristics such as gender,ethnicity, geographic location, and socioeconomicstatus.Service improvement is an umbrella term for the processes thatpush change through according to your priorities. This bringstogether the participation of healthcare professionals and patientsin improving their own care, but also the effectiveness of a team,or a department or a hospital.The Institute of Healthcare Improvement is one organization thathas taken the practice of service improvement forward asking the
question “how to improve” :
Forming the team2.
Testing changes - Plan/Do/Study/Act