My reflections on Madrid Hospitals. This is the way I see it (part 1)

As Napoleon said: “Victory has a thousand fathers, but defeat is an orphan”.

It is true that the Alzira Model has a thousand fathers, all of them responsible for its success, more than 16 years of experience and the excellent results achieved prove it. The professionals working daily have lifted the hospitals to the first position of the ranking, according to the Government’s annual evaluation of public hospitals. They are responsible for this success.

The citizens trust the Alzira Model, as shown by the satisfaction surveys. They are also responsible for this success.

Now that the Government of Madrid Autonomous Community has cancelled the tenders for the 6 public hospitals, many people will wonder who is the father of this defeat. Some of them think that the politicians are, others think that justice -which didn’t manage to rise to the occasion, causing an unprecedented legal uncertainty-, is. I firmly believe, from a perspective of more than 16 years of experience, that with this decision we have all lost.

The project could probably have been explained much better, that’s for sure. More consensus could probably have been reached, that’s for sure. But I think that our society, and the professionals who work in this sector, must be conscious of the new challenges they are facing to guarantee the sustainability of our public health system. These challenges are so serious that looking the other way just won’t sort this out.

The demography “tsunami”, the technology progress, the social changes, the ageing population, the decaying facilities etc… all these problems are not solved by shouting expressions or showing placards, witty though they might be, nor discussing in entertainment programs.

We all know the public system needs to be reformed and more professional.

We all know the challenge of chronic patients can’t be taken on by just building huge hospitals with a thousand beds. The primary care-hospital integration is essential.

We all know the pending matter of the Public System is to implement a modern policy of HR management, making the professionals feel involved in the organization.

We all know the latest technology must be acquired and implemented en masse.

We all know we have to learn from other sectors, which have considerably changed to survive.

We all know purchasing departments can be more efficient. All the hospitals don’t need all the departments.

I insist that we have all lost. This defeat is ours. Spain must choose between following in our European partners’ footsteps, or being like others, farther countries where you listen to just what you want to, which is very comfortable, but not very beneficial for the system.

If we’re happy with the forecast of 1% of growth in 2014 or a 5% public deficit, that means more than M€50,000 of deficit should be financed, if we’re satisfied with these figures in the short term, we won’t undertake the structural reforms that will allow us to grow in a long term period.

If we’re satisfied with spending more than M€13,000 taken from the Social Security, and we’re not concerned about pensions, it’s understandable that many people will be happy for the suspension of this project, which means an investment of M€100 in healthcare infrastructures, saving money that could be spent in other social areas.

Closing our eyes to this situation would be irresponsible behaviour.  Despite the pressures, threats, attacks against our organization and our professionals during all this period, I do believe in the public-private partnership, since it is a successful alternative wherever it has been implemented, in Spain or abroad. I want to invite whoever it may concern, to visit first-hand any of our projects. Most of the critical voices are ignorant of the basic principles of the model, such as the “per capita” payment, the service portfolio or the limited profit for the companies.

I’m sure the PPP projects are a future alternative in healthcare. This model needs doctors, nurses, and more medical professionals, but not lawyers. This is one more lesson to learn from the Madrid tender process.

I’m extremely satisfied for the support received from the Infanta Leonor and Sureste hospitals. Most of the professionals showed their interest in our project, and from this blog I want to thank them for their affection.  I’m also proud of the Ribera Salud team, with some of them I’ve shared very difficult moments since the model started from square one, without any previous experience, and as I always say to the younger people, we have learned from success and from failure, but always humbly and looking at the bright side.

From my point of view and my experience, I’ll keep on working for a better healthcare system, for its sustainability, and for the possibility to join private and public management initiatives, always respecting the citizen and the professional. I’m not going to take a step backward, but if I would, it would only be to take a run up. Will you come with us?

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