Standardising patient journeys to deliver quality and equity: Saudi model of care

Saudia Arabia’s health system is undergoing a deliberate and ambitious transformation. Guided by the goals of Vision 2030, and the Health Sector Transformation Program, there is clear direction from the Kingdom for a health system that is integrated, accessible and centred on the needs of its people.

The challenge now is not ambition. It is execution. How to realise its commitment to raising quality consistently across the geography, while reducing avoidable differences in outcomes between regions and population groups. The recent Saudi Model of Care Forum reinforced the scale of that aspiration: integrated care, organised around patient need, delivered consistently across clusters and sectors.

This five-part series explores the operational shifts that are required, building on the strong foundations that Vision 2030 and the Health Sector Transformation Program have established for the Kingdom’s health system.We begin with the foundation, and the key to unlocking a successful model of care: the design and standardisation of patient journeys.

Why pathway standardisation matters now

International evidence consistently demonstrates that unwarranted variation in clinical pathways is associated with poorer outcomes, inefficiencies and widening inequalities. A study of patients presenting with suspected acute coronary syndromes across four major hospitals identified that at 12 months, risks of re-admission or mortality differed by up to 56% between providers, with mean in-patient costs varying by approximately SAR 5 million annually at one outlier hospital. Importantly, these differences were attributed to variation in clinical processes rather than population need.

As the Kingdom accelerates cluster maturity, privatisation and new purchasing approaches, variation in care delivery becomes a structural risk, undermining the potential success of the Model of Care. Without deliberate pathway design, disparities in access, escalation and clinical decision-making can quickly become embedded across providers and geographies.

The challenge is amplified by the Kingdom’s unique context: delivering consistent standards across vast geography, from the urban density of Riyadh and Jeddah to more dispersed populations; integrating care across public, private and military health sectors that have historically operated in parallel; and maintaining quality standards while rapidly expanding capacity through major projects like Qiddiya, Diriyah and the Red Sea Development . Without deliberate pathway design, variances in access, escalation and clinical decision-making can quickly become embedded across providers, regions and sectors.

Mitigating that risk requires explicit definition of the expected pathway from first contact through:

• Acute management and rehabilitation
• Clarity on time-critical interventions and clinical standards
• Defined accountability across providers
• Measurable outcome metrics linked to governance

This is particularly relevant in time-sensitive and high-burden areas such as stroke, cardiac care, oncology, urgent care and chronic disease management, where small delays and inconsistent processes can materially affect mortality, long-term disability and system cost.

A national women’s health model: Driving access, equity and system coherence

The impact of system-led design is not limited to individual pathways. It is equally evident where services have historically been fragmented across the life course. One example is the transformation of women’s health services in Ireland, where CF leadership supported the development and implementation of a national model to improve access, coordination and outcomes.

Prior to this work, women’s health services were characterised by fragmentation, variable access and inconsistent patient experience. Community provision was underdeveloped, access to routine gynaecology services was slow, and equity gaps persisted across different population groups. Services were often delivered in isolation, with limited coordination across the pathway.

This fragmentation was compounded by the particular character of the maternity journey. Pregnancy and childbirth are not illnesses, yet routine health services are rarely designed with the maternal pathway in mind. Women moving through antenatal, intrapartum and postnatal care frequently encounter a system built around episodic, condition-led contact rather than the continuous, coordinated support needed to keep women well across the full course of their maternity experience.

The response was a nationally led, system-wide transformation programme. A Women’s Health Taskforce was established to define priorities, align policy with funding, and scale targeted service improvements across the system. Pathway redesign was combined with dedicated investment and governance mechanisms to ensure changes were implemented consistently, rather than unevenly across regions.

Transformation was delivered through:

• Establishing national governance through a Women’s Health Taskforce
• Conducting population-level engagement and needs assessment to define priorities
• Linking policy decisions directly to ringfenced funding and investment
• Designing and scaling priority services, including community gynaecology clinics and specialist hubs
• Embedding maternity improvements and continuity of care within the wider model
• Developing performance monitoring and reporting to track delivery and outcomes

The impact was both immediate and sustained:

• Ambulatory gynaecology achieved a ~6% reduction in waiting lists despite ~30% referral growth, with ~70% of patients suitable for clinic-based management and up to 90% discharged following treatment
• 16 “see-and-treat” gynaecology clinics established, with further expansion underway
• 6 regional fertility hubs and 5 postnatal hubs delivered, alongside 5 regional and 2 supra-regional endometriosis centres
• 6 specialist menopause clinics and 24 additional lactation consultants introduced to expand access
• Multidisciplinary perinatal mental health teams established across 6 regions
• Free contraception extended nationally to women aged 17–31, alongside a national cervical cancer elimination target by 2040

The transformation demonstrated the value of combining pathway design with national leadership, funding alignment and delivery discipline. For the Kingdom, the relevance is clear. Standardisation at scale requires not only defined pathways, but also the structures and investment needed to deliver them consistently across regions and population groups.

Quality and health equity: Designing pathways that reflect need

Designing pathways that reflect patient and population need is ultimately about safeguarding quality and reducing inequity. When care delivery varies between facilities or regions without clinical justification, those differences are most acutely felt by patients with complex needs, lower health literacy or limited ability to navigate the system.

For the Saudi Model of Care, the ambition is not only to improve efficiency, but to raise clinical standards consistently across the Kingdom while narrowing avoidable differences in outcomes between regions and population groups. That requires agreed quality thresholds, transparent measurement of outcomes across demographics and geographies, and governance mechanisms that intervene where standards are not met. Standardisation, when grounded in population need, becomes a mechanism for protecting both quality and equity at system scale.

Next in the series

Pathways alone are not sufficient. Incentives must reinforce them.

In Part 2, we examine the shift from funding activity to purchasing outcomes, and how value-based payment mechanisms can anchor pathway standardisation within the Saudi health system.