Harvard: innovation and transformation as managers of change

I’ ve come Boston where I’ve participated in a very interesting conference hosted by Harvard University on the sustainability of public health systems. It strikes me that while in universities as prestigious as this one conferences of such high level are usually held back in Spain people are more worried about simple debates. In our country, people pay more attention at the concessional model instead of looking for solutions to the challenges that threaten health care systems around the world.

I’m pleased that, for the third consecutive year, Harvard University has chosen our management model as a case study in the ‘Learning by doing’ sessions. The case itself, which was produced by Professor Regina E. Herzlinger, is of the highest scientific and pedagogical standards. As always, the conference has been an extraordinary experience and I hope that many students can learn from our experience as much as possible. From my blog, I would like to thank everyone for there kindness in reciving me. Below I would like to share with you my speech.

Good afternoon and thank you so much for inviting Ribera Salud to this prestigious university; we are so proud to present our management model here.

I would like to start by saying that in the world of healthcare management, there are two relevant concepts: INNOVATION and TRANSFORMATION.

INNOVATION is no single department or section of a company. INNOVATION is a way of doing things, not just in business but in real life. You must always ask “why?”

TRANSFORMATION is constantly adapting to different circumstances, being flexible, and understanding and accepting that things have vastly changed over 30 years. We cannot, therefore, manage and solve problems the same way we did 30 years ago.

I would like to briefly explain how the Spanish Healthcare System works. Our national healthcare system was inspired by the National Health Service in the UK. Healthcare in Spain is public, free, universal, fair, and available to EVERYONE. Healthcare is managed almost entirely by the Government.

Ribera Salud began as a public-private collaboration project, the FIRST IN EUROPE to include clinical management in 1999. After 20 years we can claim that we are internationally recognised by four elements which form the basis of our management model.

  1. The PUBLIC-PRIVATE COLLABORATION MODEL. The first time that a company managed the healthcare of a part of the population in a NHS system.
  2. CAPITATED PAYMENT. We were also pioneering in our introduction of a new financing system which strives for prevention and promoting health in order to obtain the best level of health for the population, THIS IS OF UTMOST IMPORTANCE.
  3. INTEGRATED CARE MODEL, meaning that primary healthcare, home care, mental health and the running of the hospital are carried out collectively and with the same vision, objectives, and strategy. EVERYTHING IS COORDINATED so as to give the best and most efficient response to the needs of citizens.
  4. NETWORKING, social services, councils, etc. Healthcare is not only the responsibility of one hospital or health centre; THE COMMUNITY must generate a healthy environment.

So, that’s why we consider our model and our company as an never ending innovation story. In fact, we had been an ACO from the beginning, even before this concept of integrated and efficient care became a trend all around the globe.

This is why Ribera Salud has developed a three-pronged strategy to service management. Fusing these three principles is what we call the TRIANGLE OF SUCCESS:

  • CLINICAL MANAGEMENT is a modern concept based on the work in common with different service levels united under PREDICTIVE MODELS which allow us not only to provide the best response when the patient is ill, but also PREVENT the patient from becoming ill. We prefer saying that we take care of citizens and not patients because our objective is that CITIZENS DO NOT BECOME PATIENTS. 
  • It is impossible to introduce changes in the health system if our professionals are not involved in its management. Since 1999 we have introduced pay for performance schemes to all of our projects. Also, we are university and teaching hospital and primary care centers. We understand that retaining talent and creating great teams of professionals are key to obtaining the best healthcare results. 
  • IT SYSTEMS. We were pioneers in the introduction of IT systems, in fact we added the first computerised hospital to the Spanish public health system. We are currently working with three fundamental elements:
  1. Unique electronic medical record for primary and hospital care.
  2. A health portal which allows citizens to contact their doctor or nurse, and the clinicians to contact each other.
  3. A predictive model in which we are not only giving responses to the needs of today’s citizens. We are also introducing models which allow us to empower citizens, patients and caregivers.

This is how we are working with technology. We believe that the technology is not an end in itself but the way to introduce innovation in the healthcare value chain. The path to innovation and transformation has not been easy, in fact I believe that it is difficult because the main challenge is to work on the CULTURAL CHANGE of all parties involved: Politicians, Managers (who we often let lead due to inertia or not taking risks), Professionals (who have to change and introduce new working approaches) and citizens (who must understand that if we wish to preserve the healthcare model in the long term, EVERYONE must take responsibility for their health management), whereby I believe that this rejection of CULTURAL CHANGE is an enemy we must defeat.

Finally, I would like to give you something to reflect on. Four years ago an American company, Centene Corporation, with great experience in managed care (medicare, and Medicaid) started thinking that it should start a policy of internationalisation and we were lucky enough that they chose Ribera Salud because we had so many things in common. We work for the government, we have a long-term vision for healthcare, and we opt for a clinical vision of health management with a very powerful technological base. Three years ago this company became a Ribera Salud shareholder. The combination of experience from an insurance company in a market such as the USA with a health management provider based in population health management has allowed us to start a new journey of innovation.

This means that the combination of technology, knowledge, experience, and resources has helped us make a qualitative leap towards our vision of what the healthcare of the future could look like and offer the strongest solutions.

We believe that the challenges facing modern healthcare are GLOBAL CHALLENGES which need local solutions but certainly INNOVATION and TRANSFORMATION are long-term goals and therefore I urge you all to take part using this approach.

Thank you all very much.

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