After 15 years at Johns Hopkins, most recently in charge of nursing for inpatient surgery and neurosciences at Johns Hopkins Bayview Medical Center, Zeina Khouri-Stevens says she was ready for a new challenge. Last year she joined a team of other Johns Hopkins leaders working halfway around the world to help build a precedent-setting partnership.

Khouri-Stevens is the first chief nursing officer for Johns Hopkins Aramco Healthcare (JHAH), a new company formed as the result of a joint venture between Saudi Aramco, a world leader in energy, and Johns Hopkins Medicine. In this position, she oversees more than 1,000 nurses who work in a variety of specialties—from community health to oncology, labor and delivery to surgery—at many locations throughout the Kingdom of Saudi Arabia. Khouri-Stevens says their openness to change and passion for improving patient care have helped her to quickly settle into her new role.

The scale remains daunting: JHAH serves Saudi Aramco employees and their beneficiaries living throughout the Kingdom. About 355,000 people—a number greater than the entire population of Howard County, Maryland—look to the system for medical care.

“This is a huge responsibility,” she says. “It’s humbling.”

A MONUMENTAL CHARGE

As the world’s largest oil company, Saudi Aramco thrives through the discovery of untapped oil and gas reserves and innovative production techniques. Its 57,000 workers hail from more than 75 countries.

Saudi Aramco has always provided free medical care to its employees, retirees and their family members, including parents. In 2011, Saudi Aramco selected Johns Hopkins Medicine as its partner for a groundbreaking joint venture in health care. In January 2014, the new organization was inaugurated, uniting Saudi Aramco’s long-established health care delivery system with Johns Hopkins’ clinical, education and research expertise.

Khouri-Stevens is part of an executive team based in Dhahran and made up of leaders from Johns Hopkins Medicine and Saudi Aramco. Meanwhile, in Baltimore, Laurent Moreau and his team ensure that Johns Hopkins Medicine fulfills its contractual obligations to match JHAH’s needs with Johns Hopkins’ resources. Now a managing director at Johns Hopkins Medicine International, Moreau has been involved in this work since the earliest conversations with Saudi Aramco’s leaders.

“Saudi Aramco is to energy what Johns Hopkins is to health care,” Moreau says. The company’s medical services span the entire Kingdom, about one-quarter the size of the continental U.S. The nature of the oil business requires delivering health care in a variety of locales: on an offshore oil rig, on a man-made drilling island or at gas-oil separation plants in a desert, where summer temperatures can exceed 120 degrees Fahrenheit.

Following JHAH’s inauguration, Moreau and members of the Johns Hopkins Department of Emergency Medicine took the two-hour plane ride from Dhahran to experience life at those gas-oil separation plants. Standing in soft, warm sand, they listened to plant supervisors share concerns about their employees who were far from home, family and specialized medical services. And they pondered how best to handle the casualties of a disaster, such as a gas explosion. While Saudi Aramco has carefully considered the possibilities, Moreau says, Johns Hopkins’ expertise will strengthen emergency planning.

LAYING THE GROUNDWORK

A first step for the new organization has been to establish a different management structure. Providing patient-centered care requires making decisions at many levels across multiple teams. As a model, Khouri-Stevens and the other Johns Hopkins leaders have turned to treatment delivery systems already in place in Baltimore.

“When we built programs at Hopkins Bayview, whether it was the bariatric program or orthopaedics, we had to cross lines from nursing to medicine to administrative teams. We had to get consensus,” she points out. “Everyone brings something to patient care. I have carried that approach with me, and I’m trying hard to implement it here. We have started multidisciplinary meetings and rounds.”

The joint venture specifies 21 initial areas of focus, including cardiology, minimally invasive surgery, primary care, continuing education and clinical research. Each program is co-chaired by one representative from Johns Hopkins Medicine and one from JHAH. For the clinical programs, the first objectives were to assess each area, identify goals for development or enhancement, and design a blueprint for achieving them.

Evaluating the cardiology program was a priority, given the nation’s health profile. The World Health Organization reports that 46 percent of all deaths in the Kingdom are caused by cardiovascular diseases, compared with 31 percent worldwide. Diabetes, a major cause of heart disease, is three times as prevalent there.

Saudi Aramco employees and their health care beneficiaries can now count on the vision of the cardiology co-program leads: Gary Gerstenblith and Lowell Maughan on the Johns Hopkins side, and Saad Alhasaniah of JHAH. The cardiologists aim to work with colleagues in other disciplines to build a system that provides a continuum of cardiovascular care, including cardiology, advanced electrophysiology, structural heart disease, peripheral intervention, cardiac rehabilitation, cardiac surgery and primary care that supports cardiac patients.

High on the to-do list is recruiting a cardiac surgeon to expand the services JHAH provides. Alhasaniah has already made better use of existing resources by adapting Johns Hopkins protocols. Primary care providers can now order certain evaluations like stress tests for their patients—an adjustment that allows cardiologists to focus on patients with a confirmed need for their attention.

The Johns Hopkins Hospital’s Heart Failure Bridge Clinic helps patients understand and manage their condition, lowering the possibility of inappropriate or avoidable readmission. After visiting the clinic in Baltimore, Alhasaniah identified Imad Hamdan, an internist at the main JHAH hospital, to manage postdischarge patients similarly.

The cardiology co-leads envision that their heart center will one day lead the region, allowing clinicians to conduct research and care for patients beyond the Saudi Aramco system.

Already, the partnership is contributing on a broader scale. At the Ministry of Health’s request, Khouri-Stevens and others have supported public health initiatives, such as educating citizens on Middle East respiratory syndrome coronavirus. This past winter, physicians from across the region attended a cardiology conference led by clinicians from Johns Hopkins Medicine and JHAH. The Baltimore team is working to plan another joint clinical conference, according to Moreau. 

“The ambition is really to build a system that is on par with the Johns Hopkins Health System,” he says—“one that will amplify our mission across the entire region.”

As seen in the 2016 Biennial Report. Learn more.