Government Hospitals in Riyadh City, Thesis Paper Example

How the Use of Service Level Agreements (SLA) Impacts Healthcare in Government Hospitals in Riyadh City, Saudi Arabia

Research Topic

Riyadh, shown in Figure 1, is the capital city of the Kingdom of Saudi Arabia (KSA) and the largest, located in the southern Najd region (Peterson, 2004).  Literally meaning ‘the gardens,’ Riyadh’s population contributed nearly 7 million people to the 29.65 million individuals residing in the KSA according to 2014 estimates (WPR, 2015).

As a developing nation, the historic skyline of Riyadh has been recently enhanced by two skyscrapers, the thirty-story al-Faysaliyya Center and the Kingdom Tower, adding to the increasingly dominant horizon of the KSA (CIA World Factbook, 2015).   As the second largest of the Arab states, the KSA encompasses the majority of the Arabian Peninsula (CIA World Factbook, 2015).  Founded in the in the year 1932, the KSA currently has an estimated annual growth rate of 2.2%, making it one of the world’s fastest growing economies since they control approximately 16% of global petroleum reserves, ranking the country as the largest exporter of petroleum (CIA World Factbook, 2015).

This accounts for about 80% of all budget revenues, 45% of the gross domestic product (GDP), and as much as 90% of national export earnings (CIA World Factbook, 2015).  The Kingdom of Saudi Arabia is presently ruled by King Salman bin Abd al-Aziz as of 2015, acting as both the head of state as well as the prime minister, governing through Shariah Law, which is part of the Islamic religion (CIA World Factbook, 2015).

Riyadh is a deeply Islamic region with more than 4,000 mosques that host the majority of activities that comprise the city’s social network and non-Islamic religious activities are legally prohibited, although non-Muslim foreigners are allowed to worship in private (Kim, 2015).  As a nation, the KSA has laws that prohibit women from driving vehicles, so social norms in Riyadh include gender segregation statutes (Kim, 2015).   In Riyadh, the public sector is the city’s largest employer, with numerous government ministries as well as public services headquarters and it is also an essential centre for finance, business, and manufacturing (Kim, 2015).  Approximately one-third of the factories in the KSA that produce chemicals, food, textiles, machinery, equipment, metallurgical goods, construction materials, furniture, and publications are located in Riyadh (Kim, 2015).

The KSA is a welfare state governed according to Article 31 of the Saudi constitution, which indicates that the state has an obligation to provide free healthcare services to all Saudi nationals (Albejaidi, 2010).  Statistics compiled by the World Health Organization (WHO) attribute as much as 68.9% of the total population comprise Saudi citizens and total public health expenditures during 2009 amounted to 5% of the gross domestic product (GDP) (Albejaidi, 2010; Almalki, Fitzgerald, & Clark, 2011).   The Saudi health care system is ranked 26th among the world’s 190 health systems and Riyadh also provides free access to primary health centers in addition to public hospitals guaranteed for Saudi and select foreign nationals employed in the public sector (Albejaidi, 2010). The lack of comprehensive medical coverage for the vast majority of expatriates emphasizes the necessity for such individuals to seek private health insurance while in Riyadh from providers including Axa, Aviva, Cigna, or Allianz  (Almalki, Fitzgerald, & Clark, 2011).

The Ministry of Health (MOH) is the primary government organization responsible for managing the healthcare network within the KSA, which includes Riyadh, and currently operates 62% of the hospitals in addition to 53% of the clinics and healthcare centres with the remainder being private facilities (MOH, 2013).  The MOH currently manages a total of 244 hospitals with a combined 33, 277 bed capacity and 2,037 primary health care (PHC) centres, some of which are mapped in Figure 2 with the list of public and military hospitals in Riyadh to be included in this study specified in Table 1 (Almalki, Fitzgerald, & Clark, 2011).

This makes the MOH the major provider and financer of health care services in Riyadh, Saudi Arabia, while the private sector contributes a total of 125 hospitals with a combined bed capacity of 11, 833 in addition to 2,218 dispensaries and clinics to the delivery of health care services, especially in cities and large towns (Almalki, Fitzgerald, & Clark, 2011). The WHO has defined the parameters of technological inclusion in the provisioning of health services, coining the term ‘E-health’ (Electronic Health) to describe the amalgamated usage of information communication technology (ICT) or information technology (IT) and electronic communications in the health sector (MOH, 2013).

The Service Level Agreement (SLA) is a contract established with the intent of providing clarification or guarantees in regards to the quality level of the service aspects to be expected during the interaction between a healthcare service provider and a consumer (AlYazidi & Emam, 2013/2014).  Contracting services through a SLA provides a benchmark that the MOH can use to clarify and assess the quality level of assistance provided through the healthcare system as well as the rights and duties of applicable beneficiaries (MOH, 2013).

The nature of the SLA permits the clear and unambiguous presentation of the agreement regulating the relationship between the MOH, the provider, and the recipient of services, irrespective of their knowledge of the contexts of the SLA (Weyns & Host, 2013).  Patients receiving treatment through healthcare services delivered electronically are covered under all provisions of any existing SLA through implicit and explicit consent without exclusion even if they are not aware of the existence of the applicable agreement (MOH, 2013).

A literature examination for relevant academic journalism will distribute a referential establishment that will be generated to show the applicable particulars concerning access to the SLA using various means for health education in Saudi Arabia and this information will be quantitatively analysed by regulating the details with numeric representations that will authorize statistical investigation.  This examination will consistently connect the research inquiries and viewpoints that describe resolution in the exploration. 

Previous Studies (Literature Review)

This section will present an in-depth analysis regarding the current state of the healthcare system as measured through the use of a SLA delivered in conjunction with health education through an evaluation of the recent relative literature on the current implementation of e-Health services, telemedicine, and mHealth practices effectively in play globally as well as in Riyadh, KSA.  Through this literature review, a conceptual framework will be created to evaluate current programs implemented that provide the SLA for health education and the treatment of patients in developed countries like the United States to evaluate the provisions that are currently being used in Riyadh, Saudi Arabia.

This will set the foundation for establishing that Riyadh, Saudi Arabia is experiencing tremendous growth in the provisioning of healthcare services including health educational services, telemedicine, mHealth, and e-Health to substantiate the feasibility of this solution through examples from empirical studies and existing research.  This literature review will first examine the current situation that serves as an obstacle in Riyadh, Saudi Arabia regarding access to healthcare services according to the SLA and preventative factors to the availability of the SLA through exploration of the following details:

• Various aspects regarding how the delivery of SLAs through various modalities improves overall quality in the healthcare sector in Riyadh,
• The benefits of integrating SLAs into the contexts of healthcare delivery,
• Access to SLAs that define the availability of healthcare services in remote regions of Riyadh, Saudi Arabia,
• How the presence of SLAs affects healthcare solutions in Riyadh, Saudi Arabia, and
• A global perspective of how SLAs influence the consumption of telemedicine and e-Health as well as the availability of medical treatment,

The expansion of the availability of healthcare services within the previous decades has generally resulted in the dissemination of SLAs available through diverse means to make the information easily accessible. Furthermore, promoting modernization was specifically designed to meet local requirements to support the establishment of economical advancements and occupation resources (Kelly, Mulas, Raja, Qiang, & Williams, 2010).  As of 2008, broadband service was available in 182 international markets and mobile networks exceeded one billion by the start of 2009, but more than half of the world’s nations still do not have an Internet exchange point (IXP) (Vo, Brooks, Farr, & Raimer, 2011).  The IXP serves as the primary location where traffic can be transmitted and many remote users pay exorbitant charges, as much as $2,000-$5,000 USD per megabyte (Mb) per month to transmit digital information over an IXP (Kelly, Mulas, Raja, Qiang, & Williams, 2010).

Globally, numerous nations have adopted electronic health systems in order to upgrade healthcare services by providing e-health services centred on delivering a clinical value that supports the needs of providers as well as consumers (Blumenthal, 2009).  The MOH has a number of objectives and initiatives which can be achieved through the e-health that involves working on implementing a highly ambitious program in order to achieve its innovative vision for e-health that constructs a “safe, efficient health system, based on the care centred on a patient, standard-oriented, and supported by the e-health” (MOH, 2013).

This permits the MOH to achieve tangible progress on the e-health field through innovative strategies launched within a relatively short timeframe to permit the development of an extensive five year plan to achieve great strides towards the perpetuation of telemedicine in diverse communities (MOH, 2013).  This strategy provides a roadmap for planning e-Health service programs designed to cope with the scope of the demands and needs of all citizens by mobilizing providers and staff to collaborate towards the realization of this vision (Callan, Miller, Sithole, Daggett, & Altman, 2011).  The comprehensiveness of the e-Health program integrated in Riyadh must entail a distinct perspective relative to the extent of provider liability in the SLA that distinguishes specific benefits for both the MOH and the people of the KSA (MOH, 2013).

Health Concerns in Riyadh

The Millennium Development Goals (MDGs) are eight objectives identified by the United Nations and the United Nations Development Programme (UNDP) is the specialized agency entrusted with focusing on helping underdeveloped or developing nations work towards achievement of these goals by the end of 2015 (UNDP, 2014).  These eight MDGs are to:

• “Eradicate extreme poverty and hunger
• Achieve universal primary education
• Promote gender equality and empower women
• Reduce child mortality
• Improve maternal health
• Combat human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), malaria, and other diseases
• Ensure environmental sustainability
• Develop a global partnership for development”(UNDP, 2014)

Even with international agreements to provide effective, efficient healthcare that is maintainable by adapting MDGs in 2000, access to comprehensive health coverage is still unacceptably low in many countries, with some countries achieving less than 50% of the margin necessary to obtain the goals set in the MDG for 2015 (Thomson & Mossialos, 2010). Collaborative initiatives involving formal organizational alliances, agencies, and groups have planned strategies to decrease the risk of chronic diseases and improve overall health (Atkinson & Gold, 2002). While these  gross health initiatives (GHIs) have resulted in large increases in funding for specific diseases such as HIV/AIDS, malaria, and tuberculosis, due to inadequate infrastructures, GHIs have also added a strain on some countries’ health planning and management systems (Baum, Kendall, Muenchberger, Gudes, & Yigitcanlar, 2010).

In many smaller countries, the poor governing systems, shortages of trained personnel, poor delivery structure, unreliable supply chains, and lack of proper patient health histories lead to the large differences in health status between smaller, underdeveloped nations and larger, wealthier nations (Asiri, 2014).  Efforts to create positive synergies between health systems and GHIs have been launched through the WHO, especially in countries with populations that are vulnerable to illness due to poor diets and poor quality drinking water (WHO, 2011).  With financial support from the government, these efforts are helping countries to identify solid solutions to build new knowledge and bring clarity to the issues preventing the establishment of continuous interactions between GHIs and national health systems (WHO, 2014).

In recognizing various cultural dichotomies, holistic medicinal practices have begun to grow in numerous markets worldwide.  The primary health care scenery with integrated technological knowledge has previously been accessible as an instrument for management rather than as an implementation tool for assisting, improving, and creating additional efficient specialized examinations involving medication (Carroll, et al., 2010).  Computer-based patient education is becoming of increasing significance to the primary care practitioner.  From a duty-of-care deliberation, it is useful to have a documented synopsis of the instructive resources dispersed to the consumer (Shahriyar, Bari, Kundu, Ahamed, & Akbar, 2009).  Moreover, prearranged patient edification has been exposed to advance customer contentment or gratification without addition to the discussion period.

In healthcare, the availability of the SLA has become entrenched, omnipresent, and networked, with increased possibilities for prosperous societal communications through a reliable internet connection (Baum, Kendall, Muenchberger, Gudes, & Yigitcanlar, 2010).  Such expertise can have an immense influence on the provisioning of healthcare services, but the challenge will be to recognize how to utilize technologies to convert knowledge into a flawless section of everyday life (Blumenthal, 2009).

Healthcare in Distant Areas

Public health information systems have reformed only progressively in the previous thirty years through integration of health informatics (HI), which refers to “applied research and practice of informatics across the clinical and public health domains” (Asiri, 2014, p. 26).  In most major city hospitals, there have been telephones on the counters of numerous medical wins for many years (Donner, 2004).  Conceivably, the emergence of personal computers (PCs) as common household items over the past few decades has changed the operational capabilities of even remote healthcare centres, enabling distant communication to occur between personnel in diverse locations (Blumenthal, 2009).  These difficulties place the provincial hospitals within larger cities as the only source of modern medical treatment, especially for those with complex health conditions.

However, the acquisition of technological equipment such as photocopiers and printers is as well as document and toner is extremely difficult to obtain in many remote areas of the KSA, making the presence of widespread systems of information an unrealistic venture (Atkinson & Gold, 2002).  Primarily in the pastoral communities, communication tools were tenuously established, allowing the data to steadily progress connecting the centre and the periphery, and infrequently relating the remote sections of the local health program (Telmesani, Zaini, & Ghazi, 2011).  Particularly each institution receives benefits of not only the exceptionally observable wireless and transportable equipment, but also less observable improvements designed to inform associations transmitting data.

However, pioneering attempts to resolve these situations that address various insufficiencies in the connectivity and information-processing capabilities of the integrated technological devices intended to improve local health programs are stagnated by the by the availability of the relevant upgrades (Cutler & Lleras-Muny, 2007). Telemedicine serves as an incomplete solution to the dilemmas of contributing medical care to isolated cities or to limited areas underserved by physicians or healthcare specialists (Vo, Brooks, Farr, & Raimer, 2011).

Telemedicine has also been integrated in inner-city healthcare delivery in diverse locations in the KSA in an attempt to meet the increasing demand for healthcare services (Istepanian, Woodward, & Richards, 2001).  Medical expertise, such as radiology, psychiatry, dermatology, and language therapy have exercised telecommunications effectively (Tsai, et al., 2014).  Numerous studies have identified a wide diversity of clinical missions that can be significantly achieved using various technological devices (Weyns & Host, 2013).

The demand for telemedicine is remarkable in the presence of major obstructions to establish a high standard of healthcare (Smith, et al., 2013).  The unequal geographic distribution of healthcare workers and resources remains a problem that interferes with the ability of healthcare providers to keep up with a rapidly changing body of knowledge (Naismith, Lonsdale, & Sharples, 2003).  Additionally, it is not fiscally possible to provide medical specialists, the highest-technology equipment, and major information supplies in each infirmary and clinic department (Varshney, 2007).  One particular limited resolution to these problems is to increase healthcare contributor availability to experts and information via telecommunications at the time they demand assistance.

SLAs and Healthcare in the Riyadh

The unique aspects of Shariah Law that governs the KSA necessitate explicit identification of the contextual dynamics of the healthcare services available to Saudi citizens.  Specification of which services should be provided through the SLA as well as the associated costs, availability, and other details need to be explicitly agreed upon (Weyns & Host, 2013).  This written contract between the hospital and the patient is documented in the SLA, which can also exist as an agreement between different administrations that outsource their technological management to an external contractor or interdepartmentally between the organizations own department and the rest of the company (AlYazidi & Emam, 2013/2014).

The purpose of the SLA is to facilitate communication between the various partners, especially concerning the responsibilities and the scope of the services offered by their department (Weyns & Host, 2013).  An SLA concerns technical characteristics of a service. A service level agreement is an agreement regarding the guarantees of a web service. It defines mutual understandings and expectations of a service between the service provider and service consumers. The service guarantees are about what transactions need to be executed and how well they should be executed. SLA concerns agreements on the availability degree of a Web service (AlYazidi & Emam, 2013/2014).  The SLA identifies the services provided by the hospital, but also serves as an information source detailing the boundaries that these services are restricted by.

Provisions of SLAs at Hospitals in Riyadh, Saudi Arabia and Other Countries

Hospitals use the SLA to detail all of the aspects that apply to the delivery of electronic services.  The SLA of the King Faisal Specialist Hospital & Research Centre (KFSH&RC) highlights all of the guidelines regarding the electronic availability of services such as the ability to view, postpone, or cancel appointments, get medical reports, request refills, contact personnel employed in patient relations, modify their personal information, make requests for social services, and request replacement medical supplies (2013).

The SLA for the King Fahad Medical City (KFMC) details provisions for a similar assortment of electronically available services to those offered on the website of KFSH&RC.  Electronic services offered via the KFMC website are intended to serve employees as well as patients, vendors, and the general public to provide the user with an easy, fast, and efficient way to access the data they need anywhere and anytime (KFMC, 2015).

The KFMC website presents a SLA that details the guidelines and restrictions for accessing details regarding upcoming appointments, medications, lab tests, radiology, diagnosis, reports, and profiles of relatives (KFMC, 2015).  The network of services for the public has a SLA that describes provisos for public access to medical referrals, health education, international days, patients’ Fatawas, important contact numbers, patient satisfaction surveys, and some general information (KFMC, 2015).

As a military facility, the Prince Sultan Military Medical City (PSMMC) offers categorical services for patients, job seekers, people seeking to purchase medical products, those that have children with birth defects seeking treatment, and those in need of higher military services (PSMMC, 2015).  The SLA for PSMMC distinguishes the usage conditions for patients to access information regarding their appointments, patient registration, visiting hours, admission, visitation and escorts guidelines, and a map of the building (PSMMC, 2015).

When compared to the SLA for other facilities such as Bellevue South Manhattan Medical Centre (BSMMC) in New York, both SLAs indicate that user information is password protected and encrypted so that every user must have proper login credentials in order to access details, but the SLA for BSMMC differs in that it includes a patient’s bill of rights that explicitly details the privileges patients are entitled to when seeking medical service.  This is made available electronically (BSMMC, 2015).  The BSMMC website also differs from hospital websites in Riyadh in that the BSMMC website includes a patient’s privacy notice that is made available in numerous languages and details that can be used to lodge a complaint (2015).

Summary of Previous Studies

Examination of existing literature has detailed the numerous health concerns facing citizens of Riyadh and also illustrated the unique circumstances encountered when trying to provide healthcare services to those residing in distant areas.  This section also provides an understanding of the SLA in regards to the information provided in its context and how it is intended to aid the user.  While this proposal only includes a few examples describing the provisions of SLAs at hospitals in Riyadh, Saudi Arabia and other countries, the completed thesis will discuss the SLAs of each of the government and military hospitals listed in Table 1 as well as other hospitals in various American states, England, Italy, Canada, and Switzerland.

Research Goals/Objectives

The goals and objectives of this thesis is to provide an overview about the use and importance of SLAs at government and military hospitals in Riyadh, Saudi Arabia with primary emphasis being made to the influence of the SLA on service provisioning as a form of technological integrations.  This thesis will evaluate the efficacy of providing medical treatment and health education via the use of SLAs in government hospitals in Riyadh City.  In order to achieve the MDGs for the nation of Saudi Arabia, these issues must be overcome to stop the unnecessary spread of preventable or treatable diseases and illnesses.

The information delivered in the SLA is a preferred basis on the individual client requirements.  The consumer can request explicit subject knowledge through a professional to increase the information they have regarding their health situation.  This characteristic contributes a response to the dilemma of connecting data that is legitimate, dependable, detailed, and personal.  The customer can also create individual remarks for their healthcare professional.  Use of e-Health and other services necessitating a SLA can facilitate persuade both self-sufficient and collaborative knowledge experiences.  The specifications of the SLA detail what services the patient is entitled to, which identifies the opportunities available through the indicated service provisions.

Hypotheses and Research Questions

In order to establish a foundation to comprehensively satisfy the research aim and objectives, the following research questions and hypotheses will be adopted as the primary focus of this study. 

Research Questions

The goal of this research study is to gain an understanding regarding the impact integrating SLA measures has on the delivery of healthcare services in government and military hospitals in Riyadh City, KSA.  The main intent of this research is to evaluate the relevance of the SLA in the specific context of integration for healthcare services in government and military hospitals in Riyadh City and examination of this topic will be guided by the following research questions:

Do the government hospitals in Riyadh have a SLA available electronically?

1. If they do, what are the factors that are written in these SLA?

Does the presence or absence of the SLA affect the quality of healthcare services the patients that visit government hospitals in Riyadh receive?

1. If they do, how can the SLA be properly evaluated so each one can be comparatively measured the gauge the current quality of the healthcare services provided by the government hospitals in Riyadh city?

These research questions will aid in the development of the conceptual framework that will be used to design the research instruments and will also provide a benchmark that can be used to measure the veracity of the hypotheses.

Research Hypotheses

The researcher will be aiming at finding out whether and how organizations should invest for the integration of comprehensive SLAs, which details the included provisions that will underlie the applicable healthcare services.  Examination of the topic according to the research questions will attempt to test the following hypotheses:

• Riyadh has experienced significant growth, but there is no telecommunication infrastructure in remote areas.Therefore, the first hypothesis is: The majority of the government hospitals will not have SLAs.  It is also hypothesised that the SLAs that are present contain similar or identical provisions detailing the healthcare services provided in government hospitals in Riyadh. 
• Due to the high illiteracy, unemployment, and poverty rate prevalent in some areas of Riyadh, it is feasible that even when the SLAs are present, patients are unable to benefit from them.The second hypothesis is: The presence of absence of the SLA does not overly impact the quality of services provided by the government hospitals in Riyadh.  It is also hypothesized that the SLAs that are present tend to contain similar elements for easy comparison. 

Assessment of this research topic based on the designated questions and hypotheses will provide a unique perspective that will aid in understanding the interactions between SLAs and the provisioning and consumption of healthcare services in Riyadh City.  This will form a basis for academics who intend to study the impact of engagement in the design and development of healthcare programs globally and especially in Riyadh.

Research Methodology and Methods

The research methodology used for this thesis will entail mixed qualitative and quantitative methods (Thomas, 2003).  The data obtained from both primary and secondary research methods can then be evaluated together according to how they relate to testing the hypotheses (Creswell, 2009).  Theories should not be included for the sake of having a theory if the included details will not enhance the study, provide clarification of a concept, or add relevancy to an idea proposed or being tested within the context of the study.

Research methods are the tool used during the process of conducting scientific analysis in order to assess various situations through both first-person observation and secondary research of academic published materials (Thomas, 2003).  The included research methods like secondary qualitative research and primary quantitative research approaches assist in development of hypotheses to prove or disprove various theories related to a specific subject (Creswell, 2009).  Provision of a theoretical or conceptual framework to guide a research study helps the researcher to maintain focus on the ideas or principles of practice being examined and provides a basis for activity and selection of methods used within the study.

Evaluative inspection is explored to deduce the impression of a specific social intervention or system expected to resolve a social dilemma (Babbie, 2007).  The research can then be appraised into informed assertions according to presumed hypotheses to prove or disprove their foundations so that development of practical conclusions and recommendations for improvement can be proposed (Creswell, 2009).

Quantitative methods are exploited within research backgrounds to convert information to a mathematical diagram that is simple to analyse (Babbie, 2007).  The use of quantitative methods rely less on interviews, observations, questionnaires, focus groups, subjective reports, and case studies, but remain focused on the collection and analysis of numerical and statistical data (Neuman, 2006).  Determinations made though quantitative research can be supportive of or against the hypotheses being tested and use deductive reasoning to determine if the hypotheses are proven or disproved  (Render, Stair Jr., & Hanna, 2011).

Qualitative research collects and analyses data to gain an in-depth comprehension on how people behave in specific situational contexts (Creswell, 2009). The main objective of qualitative research is to conduct appropriate assessments of human actions to determine the reasons governing their behaviour and the underlying meanings related to why they respond to certain situations in specific ways (Babbie, 2007). Qualitative research methods focus on an inductive reasoning process where the hypotheses are tested against suppositions from the research analysis to determine if they were correct in their assumptions or not (Neuman, 2006).

The strengths in each of these examination progressions is that they help to organize a comprehensive investigation regarding the efficiency of using ICT with SLAs in health education to accomplish MDGs in Riyadh, Saudi Arabia based on the intensity of such achievement in other improved countries, developing nations, and obtainable programs already implemented, with special emphasis on how these methods are influenced by the SLAs.  Evaluation of available empirical discovery will allow determinants that will cause a reaction to the principle research inquiry and confirm or invalidate the speculations through supporting specifics established within the existing literature.

Internet-based and library documents seek for intervention studies (as illustrated above) in developing countries was commenced operating the following conditions: “telemedicine,” “Riyadh,” “MDGs,” “e-Health,” “mHealth,” “telecommunications,” and “wireless,” in various combinations with “healthcare” and “physical condition.” Search databases included MEDLINE, CINAHL, (nursing and allied health), Google Scholar, ProQuest, Project Muse, IEEE, and JStor.

The study will primarily engage in archival research as a means of collecting relevant data for examination.  Archival research involves drawing conclusions by analysing existing sources of data, including both public and private records.  The key thing you should note right away is that most of this process involves making decisions ahead of time so that the process of data collection is smooth, simple, and systematic (Newman, 2011).   Archival research provides a test of the hypothesis by examining existing data and, thereby, avoids most of the ethical and practical problems of other research designs. Related to this point, archival research also neatly sidesteps issues of participant reactivity, or the tendency of people to behave differently when they are aware of being observed.

The research will use a questionnaire administered within all the government hospitals in Riyadh city included in the study.  The purpose will be to collect data regarding all SLA factors that are mentioned in the SLA of each government hospitals in Riyadh city to answer the first main and sub research questions.

Following the collection of the data detailing the SLA factors mentioned in the SLA of each government hospital in Riyadh city, another research questionnaire will be administered amongst the patients to measure the patients their knowledge of the SLA that was provided from these government hospitals in Riyadh city.  Specialized software developed by the researcher for the completion of this study will be used as a tool to help measure the SLA and assign a level of degree for each SLA of each government hospital in Riyadh city, organized according to the SLA factors that we are collected from the research questionnaire. The factors will be hierarchically categorized in three level of degrees (A, B, C) as (Excellent, Good, Poor) and these designations will be used as a degree to evaluate the SLA of each government hospitals in Riyadh city to answer the second main and sub research questions.

More specific details regarding the methodology that will be used to conduct this research will be provided in the main thesis following the performance of the actual techniques.

Expected Thesis Organization

• Title Page
• Abstract-Comprehensive summary of thesis
• Definition of Terms-defines acronyms used in the thesis
• Introduction-Introduce the topic; present the aims, research question, and hypotheses.
• Literature Review- Provide literature review that provides a conceptual framework and thoroughly examines current research regarding the healthcare system in Saudi Araba, the use of e-Health services, and how the SLA influences service provision
• Research Methodology- Explain the methodology used to conduct the research and explain why the method was chosen
• Results- Present the outcome of this research through the use of charts, graphs, and narrative account and
• Discussion- Provide an analysis of the findings
• Conclusion- Present the conclusions gathered from the research and indicate areas for further research
• References

Research Timetable

Once the official proposal is approved, the entire research will be conducted within the span of ten to twelve months, as outlined in Table 1.  The first 2 phases of the work will be spent reviewing and collecting the survey results and literatures using on line data bases to gather educational reviews, inter-library services, and personal contacts with colleagues in the field to expand the literature review during the third phase.

The search and analysis will be used to sort out the useful results of our research.  This may take approximately two additional months.  Known and new results ascertained through the study will provide the utilities of work and this process may take approximately four months.  During the final stages, empirical data will be presented to give a realistic perspective, which may require 2 months for phases four and five. Transcribing the material and composing the thesis may take 2 months for the final composition of the thesis during phase six.  Additional time is integrated into the plan to serve as a cushion to ensure that all segments of the study remain within their allotted timeframes.

References

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Almalki, M., Fitzgerald, G., & Clark, M. (2011). Health care system in Saudi Arabia: An overview. Eastern Mediterranean Health Journal/La Revue de Santé de la Méditerranée orientale, 17(10), 784-793.

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Babbie, E. (2007). The Practice of Social Research (11th ed.). Belmont, CA: The Thomas Wadsworth Corporation.

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Callan, P., Miller, R., Sithole, R., Daggett, M., & Altman, D. (2011). mHealth education: Harnessing the mobile revolution to bridge the health education and training gap in developing countries. Report for mHealthEd 2011 at the Mobile Health Summit (pp. 1-44). Cork, Ireland: iheed Institute. Retrieved from http://openlmis.hingx.org/Share/Attachment/1445/iheedreport_2011.pdf

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