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32 years working for close, sustainable and innovative healthcare

26 noviembre, 2021 • By

In this blog I would like to share some words of thanks for the New Medical Economics award which I received on 15th, November, in Madrid, for the work carried out during my career. 

Firstly, I would like to thank this renowned medium of digital communication, edited by Health Economics S.L. and managed by Doctor José María Martínez García, economist and Doctor of Medicine, for this acknowledgement of my experience in the health sector. However, in addition, I also want to dedicate it to all those people that in these 32 years have joined me in working for responsible, excellent, sustainable and transformative healthcare. I have learned from all of them and together we have shared challenges and proposals, worries and achievements. In my speech infront of a packed audience which gathered at the Jiménez Díaz Foundation, I wanted to give a special mention to the Communication, Marketing and Corporate Social Responsibility Manager, Angélica Alarcón, who has accompanied me for the majority of this journey.

I am passionate about the health sector. I have been working towards closer, more human, sustainable and innovative healthcare for 32 years and all of those adjectives are shared by those of us that met on Monday at the NME awards. This connection, invisible but real, is largely what motivates us to continue working, each of us from our own organization, on building the healthcare of tomorrow, today. 

And we need to think about the immediate future now. This is because we are going to face big challenges in the next few years and we should look for what unites us and that which allows us to give the response that the citizens deserve. Above all, in order to guarantee them an integrated, universal socio-healthcare, without waiting lists, which integrates the different levels of care – from Primary Healthcare to care homes for the elderly – and permanently establish this new digital culture, something which is a pending matter, so that our healthcare is a global benchmark due to its quality. 

At Ribera Group we have dedicated our work to helping to build a strong public system, from our innovative and sustainable model, with responsibility, institutional loyalty and the confidence that good health results and patient and professional satisfaction give us, after more than 20 years managing hospitals and health departments. 

I am sure that we will go from strength to strength on this path that we began  on many years ago and, between us, we will manage to secure the pillars of a single form of healthcare, one that is transformative and universal, without anyone taking ownership of it.

Thank you to those who have accompanied me in these 32 years of professional career and mutual learning. My hope is that life allows me to keep working and providing my knowledge and experience in the sector in order to continue transforming healthcare and preparing it for the immediate future. 


English

A responsible health model for a better world

15 noviembre, 2021 • By

Let me share with you all my article published in the spanish digital newspaper El Español on 11th November 2021 about Sustainable Development Goals

Leaving the world in a better way than what we found it, thinking about the future with strong foundations in terms of well-being and designing tomorrow with sustainability, efficiency and solidarity as criteria. This should be the objective of citizens, companies, organizations and institutions. And in order to do that, the roadmap set out by the 2030 Agenda is key as well as committing, without hesitation, to the Sustainable Development Goals (SDG) that, with the tragedy of Covid, are becoming even more important. Each one in their area of activity, on a small, medium or large scale. The important thing is to unite so that the foundations of this welfare society, which we are fortunate to experience as citizens in the first world, are extended to every corner of the globe and are sustainable over time. 

For the first time, we have the opportunity to commit to some good objectives for both the planet and for humanity, with inclusive, impartial and depoliticized language, which unites and does not discriminate, and which attracts due to the strength of its message. In my opinion, it is important that it goes beyond political ideals and personal interests. 

Ribera has been a pioneer for quite some time in the development of a responsible health model, with the aim of improving the well-being of the population, adding value by combining innovation and humanization, whilst, at the same time, contributing to the sustainability of the healthcare systems. For that reason, when the 2030 Agenda appeared, its integration into our day-to-day operations was immediate and natural. This is because our vocation is to transform the way of managing health, and although we are in line with the SDGs in general, our focus in on number 3 which refers to health and well-being. 

Technology and human resources are essential for this responsible health model that we apply and that we are working hard to expand, beyond the nine hospitals and 60 primary care centers that we manage in five Spanish regions. Both are key in that they allow us to provide all patients with access to personalized, preventative, predictive and participatory healthcare. We make sure that they feel they are at the center, actively participating in their care, and provide them with the technology and the support that they need, as well as facilities and equipment adapted to people with functional diversity. Equality, universality, fairness and responsibility. All of them applied to health. 

Furthermore, thanks to our commitment to research and co-innovation, we develop tools, applications and predictive models every day, such as that which, as of more than a year ago, allows us to predict which Covid patients may end up in the ICU, the telemonitoring of chronic illnesses, telerehabilitation or a virtual carer which, thanks to voice technology and artificial intelligence, “understands” patients, sends their vital signs to a healthcare professional almost immediately and is capable of handling thousands of patients in a few hours. 

We must always keep moving forward and commit to initiatives that seek to make what still seems a utopia in a world that is becoming more and more skeptical, a reality, little by little. And I genuinely think that Ribera forms part of that group of brave people that work and reinvent themselves everyday to create a better world, in our case, even greater, faster, more humanized and socially responsible healthcare. Therefore, for example, we recently joined the One Health strategy, which promotes a global vision of health all over the world. Covid and the global pandemic that it has caused should make governments and health organizations aware of the importance of approaching the health and well-being of the population from a holistic point of view, since the health, economic, social and cultural constraints greatly influence the organization and planning of healthcare resources in both prevention and caring for the population. 

No government should make decisions that affect the health and well-being of the population based on, for example, a political agenda built on confrontation, without valuing results and objective data. Yet, unfortunately, some political leaders are following a prehistoric agenda, and are still committed to 50 year old management models, serving a society that, quite simply, does not exist anymore.

And how can we guarantee a healthy life and promote well-being and health for the citizens of today at the Ribera group? With a strong and firm commitment to prevention and education for the health of the population, for all ages and stages of life, from the youngest, to pregnant women and the elderly, making medicine personalized, responding to the challenges of this new society. Covid has resulted in everything being a challenge in this area, as it has forced us to contemplate other kinds of actions, different from those organized before the pandemic started, where face-to-face workshops predominated. In March, 2020, everything changed, first due to the lockdown and later because of the social distancing needed which is still recommended today. That led us, during the first lockdown, and thanks to the involvement and initiative of our professionals, to launch our Cuídate en casa (look after yourself at home) program, which included videos with advice about health, exercise, healthy eating and online mindfulness, relaxation and rehabilitation workshops. It was so well received that it led us to record a second edition, with new videos for every type of patient, which can be seen on our YouTube channel. 

With each of our actions today, we are defining how we want the world to be tomorrow. Are you on board?


English

The Ribera Salud doctrine

19 julio, 2021 • By

Last Thursday we were informed about the Supreme Court’s (SC) ruling number 952/2021’s regarding reversions and the adherence to the 2012 Budgetary Stability Organic Law and that the fact that it, without a doubt, affects the case started by the Valencian regional government for the internalization of the management of the University hospital of Torrevieja.

But allow me to share my thoughts on the aim of this case, because I think that it is so important that it goes beyond the specific examples of La Ribera Hospital, that of Torrevieja or the healthcare concessions. It marks a before and an after in the Spanish economic system and in the concessional model in any sector, and creates what, from now on, we are going to call “the Ribera Salud doctrine”.

And what does this doctine, that has set the standard with the Supreme Court’s ruling, consist of? I have summarized it for you into some key points which are included in the Supreme Court judges’ document.

  1. The Ribera doctrine has managed to set a limit regarding economic populism in Spain. From now on, governments cannot make arbitrary decisions without opening an administrative record which includes the strict economic and budgetary impact and is backed up with data. With this ruling, we have made sure that in the future decisions of an ideological nature are not made, without explaining and justifying the economic implications of that decision to citizens, as well as how their internalization proposal will affect the quality of services, in a transparent way.
  2. This Supreme Court ruling voids the previous ruling from the Valencian Community’s High Court of Justice (TSJCV), which stated that a government could make unilateral decisions, without any type of study or analysis of the impact of these decisions. With the Supreme Court case, this ruling is now void, something very extraordinary in the Spanish legal system and very very significant for the concessional sector in general.
  3. And I’d like to add something else. The Supreme Court’s ruling states that PRIOR to making a decision and PRIOR to any communication regarding the internalization of a service (the end of a concession), the administration has to compile a comprehensive and substantiated file, which includes the evaluation of the economic and budgetary impact of this decision. BEFORE MAKING A DECISION.

From my point of view, it’s a historic ruling, which marks a before and after in terms of the guarantees of a democratic state, opting for the legal safety of concessionaire companies and guaranteeing the strictness and seriousness of the government when making decisions that affect any public service that citizens receive.

I feel proud for having taken this issue to the Supreme Court and for having managed to void the ruling of the Valencian High Court, which endorsed arbitrariness in governmental decision making, when it affects a public service. It has always seemed bad judgement to us at Ribera and now the Supreme Court has shown that we are right by voiding it.

Today Spain is a safer country, from a legal point of view, and a limit has been set regarding economic populism. And I am happy to have contributed to a stricter, more serious and more objective scenario than that which existed previously. In my opinion, it is not acceptable that a decision on the scale of the reversion of the administrative concession is justified by appealing to a government agreement, whether it be the Botánic agreement or any other, and regardless of which parties form it. Governing for all citizens is a responsibility which should be carried out with seriousness, objectivity and strict criteria and, above all, by justifying decisions with reports and data, decisions that affect so many families and, in this case, thousands of patients and healthcare professionals. What is more, this is during a pandemic and healthcare crisis.

Furthermore, we are asking for European funds to get out of a very severe crisis and it is not logical or reasonable to ask Europe for funds on the one hand and on the other hand to ignore the saving, in the case of Torrevieja hospital, for example, estimated by the region’s Court of Auditors to be 45 million euros.

I also want to place value on the social contribution of the Ribera group. We don’t want medals, but one thing is for sure, thanks to this ruling, that we have taken to the highest body within our judiciary, we have prevented other companies that manage public services from going through what we went through. The concept of company freedom, institutional loyalty between administration and a concession, respect and legal safety is essential, and even more so in a country in which public private collaboration is a reality in many sectors. And I’m talking about infrastructure, energy, water, care homes, education, MOTs and, of course, healthcare, since healthcare agreements exist in many Spanish regions.

I’m aware that we have been like David facing Goliath in this legal battle and, for that reason, I feel especially happy that the whole organization has defended affected patients and professionals, as well as our providers, subcontracted services, collaborators and, ultimately, all those who believe and appreciate that loyal, sincere and quality collaboration is also in the citizens’ interests. We have, I reiterate, simply defended the safeguards of the rule of law.

Lastly, I want to say that we trust that the contribution of the “Ribera Salud doctrine” to a great nation such as Spain allows us, and future generations, to enjoy a freer and safer country to invest in, create employment, generate opportunities and offer quality services to citizens. A country in which the ideology doesn’t put limits on freedom, in which attitudes and decisions that attack sectors such as subsidized schools, care homes, pharmacies or the healthcare sector disappear.

We trust, and we have never stopped trusting, in goodwill, dialogue and loyalty to find the best solution together with the administration, and to keep guaranteeing a responsible health model and the best public healthcare service for patients in the areas that we manage.

This is, and always has been, our vocation.


English

For responsible health

12 julio, 2021 • By

In today’s blog I want to share an interview that I had recently with  La Voz de Galicia.

The Ribera Group and Centene’s commitment to the Galician Community has been evident for several years. We manage three hospitals there: Ribera Povisa, in Vigo; Ribera Polusa, in Lugo; and since just a few weeks ago, Ribera Juan Cardona in Ferrol. And it is for that reason that in the interview I express, once again, the methods to make the healthcare system sustainable and I firmly reiterate that it would have been impossible to respond effectively to the pandemic without the collaboration of the private sector. We are committed to a responsible health model, and that is the key to facing the challenges of the system and guaranteeing its sustainability. 

You can read the interview below.

The third biggest North American insurance company, the giant Centene Corporation, has three hospitals in Galicia, through , their Spanish affiliate, Ribera Salud. The executive director for Europe, Alberto de Rosa (born in Valencia in 1962, “the 17th, October, like Pablo Iglesias and  Isabel Díaz Ayuso”, he insists), reflects on the challenges of the healthcare system after Covid.

– The pandemic has brought to light the need for strong heathcare systems. What role can private healthcare play?

It would have been impossible to repond to the pandemic effectively without the collaboration between private healthcare and public administration. The sector has collaborated loyally. It is a lesson from this pandemic: we should seek lines of communication. We must rethink the healthcare system and the role that we want private healthcare to play.

If public healthcare would not have coped with everything, as is said, it could be interpreted that what is needed is to strengthen it.

Everything has to be strengthened. We have a great public system, with values that we all want to keep: universal, free and with equality. But the society in which we live has to be taken into account. 22% of citizens decide to take out private health insurance, in addition to the public system. Why? Because people want the peace of mind of the public system but they want to have flexibility, the ability to choose, the immediacy and closeness of the private sector. We want a strong public system and in order to get that we need an outstanding private system.

-It is strange, because in the 2008 financial crisis the number of people taking out private health insurance also increased. If the system were strengthened and waiting lists were eliminated, would there be less people insured?

– I am one of those who likes to speak less and less about public and private. It is motto that I want to introduce in the group: a responsible health model.

– What does it mean?

We have to look at the challenges that the system faces. The fundamental aspect is sustainability, both in the public sector, financed through taxes, and private, financed because people pay for it. Some insist on making distinctions, when people have a clearer picture. To sustain the system everyone involved has to contribute.

-You speak about re-thinking the system. Share your thoughts. 

We have to advance to a more digital health system. We were the first group to implement electronic records and we’re implementing a health portal. We have a healthcare system that was designed in the 80s, and society is different. The hospital has to break down its walls and have  more to do with primary healthcare, social services and the patient’s home. 

– How can the system be made sustainable?

There are challenges such as the evolution of costs, ageing, new diseases, technology etc. I would propose going back to doing what was done at the start of the 90s, the April report, in which the healthcare experts pool their ideas.

– Do you like the methods that the April report proposed? It spoke about co-payment, public-private collaboration etc.

I have never advocated for co-payment, it can be unfair. There are other ideas that I agree with. A lot of things need to be re-thought.

-In the 90s, Ribera Salud started the Alzira model: the Valencian Community was responsible for the management of the whole area of health, hospital and primary. Is that the model?

There are a lot of grey areas in healthcare. The model was very interesting for some specific situations. It worked very well, allowing multi-million investments. There are other forms of collaboration that have worked incredibly well, such as Muface, in which civil servants choose between receiving healthcare in the public system or in private companies, or pharmacy offices, for example.

– The PSOE and Compromís government let Alzira’s concession expire and they have already announced the same for Torrevieja.

Three years later, Alzira’s return back to public management was a disaster. Public data shows that it costs the Valencian Community 80 million a year more than before. Waiting lists have tripled. Citizens had quality healthcare. In the middle of a pandemic, it would be worth not trying to fix something that isn’t broken.

  • «We want to work very closely with Sergas» 

In October, Alberto de Rosa left his position as CEO of Ribera Salud to become the Executive Director of Centene in Europe. He says that he only asked to keep one position: that of the president of  Povisa’s Nursing School trust.

– They have bought three Galician hospitals in less than two years. Why this sudden interest in Galicia?

We had a very close relationship with Povisa for a long time and expanding into Galicia acquiring Povisa was an extraordinary opportunity, one of which we feel very proud. When we expand into a community, we study if there may be other opportunities. Polusa (Lugo) and Juan Cardona (Ferrol) appeared and we’re happy. But the initial idea was to incorporate Povisa into the group. When we started in Galicia we were only present in two communities (Valencia and Madrid), now in four (with Galicia and Extremadura) and I can now announce that we will soon be present in five.

– Which? 

I’m not saying any more. In the countries where we are present we are going to commit to continuing to grow. 

– In Galicia too?

We’re open to any opportunities that come up, but I’m not going to say anything else.

– You took over Povisa in December and the pandemic came in March.

It was very fortunate for the group, which received a great deal of help from Povisa, and I also like to think for Povisa. Groups can help in situations like this.

– What kind of relationship would you like to maintain with Sergas? Your three hospitals have agreements.

I would like to work very closely with them, helping them and providing them with ideas and initiatives that could be positive. The concept of loyalty is important for us.


English

Nurses, the soul of the healthcare centers

6 julio, 2021 • By

Last Sunday I had the honour of participating as the keynote speaker in the graduation of the CEU Cardenal Herrera University of Valencia’s 17th year of nursing. It was a very moving ceremony and it filled me with pride addressing the new nursing professionals, one of which was one of my children. They are very well prepared and, above all, they are eager to demonstrate that their profession is vocational and that they want to take care of our health from now on.

You can see my speech below.

Dean, Vice-Dean, members of the CEU Cardenal Herrera University’s teaching staff and educational community, and especially new GRADUATES and their families who are following us at home.

It is an honour to address you as the keynote speaker at the CEU Cardenal Herrera University of Valencia’s 17th year of nursing graduates.

Dear nursing graduates.

Today is a day filled with emotion and one in which I share the happiness of both what you have accomplished and what you represent as professionals within the nursing group to which you have joined as of today. For these reasons, I want to express my sincere congratulations and appreciation.

Today you have come to the end of your initial preparation in this great profession and have reached the finish line. Carry out your profession and your vocation with bravery and limitless devotion. But my duty as THE KEYNOTE SPEAKER is to tell you that, in practice, TODAY IS NOT THE END OF ANYTHING, BUT RATHER THE BEGINNING OF EVERYTHING. The start of the route that you have chosen for your professional life, is a route that, without a doubt, is going to be passionate, but involves great RESPONSIBILITY.

Allow me to address you as a man in the street, as a healthcare manager, and also as the father of a student from this year’s graduation.

As a citizen I want to begin by expressing my deepest gratitude. Thank you, thank you, thank you so much. This tragic pandemic has placed value on many things, the most important of which is, without a shadow of a doubt, the role of all of the healthcare professionals facing the biggest crisis of the last century with bravery and dedication. You have started to form, and have already formed, part of history, the best part of our history, being those brave people that studied, finished their studies and faced a terrible pandemic. YOU ARE TERRIFIC.

This pandemic has brought to light the importance of your role in the system. We have been able to see over the last year how people come to our health centers worried and afraid, and IT IS YOU that have been there and YOU that continue to be there on the front line of healthcare.

I could tell you a lot of stories about what has happened in our health centers during these tragic months, stories that are lovely, tough, HUMAN, examples of vocation and devotion, of personal and professional involvement etc. but what I will tell you is that there has always been a nurse in each and every one of these stories. I feel such pride.

This is because, in addition to treating this treacherous disease that has had to be faced alone, nursing professionals have accompanied patients at all times, they have held their hand when they have needed it and have dried many tears but they have also given the encouragement and hope that all patients, and their families, need at difficult times.

YOU ARE THE HEART AND SOUL of the health centers!

Friends. Health is the most precious gift that we have, and you, as graduates in nursing, are a key part of health promotion, disease prevention and patient recovery, in other words, of ensuring the well-being of our society. This is all done with respect, generosity, humanity, dedication, a strong work ethic and continuous training to which you have committed yourselves with your life choice: your professional career.

The word RESPONSIBILTY in professions that are vocational and focused on taking care of people, implies COMMITMENT, RESPECT AND MATURITY.

Remember what I’m about to tell you now.

You are going to be responsible for our health at the most difficult and delicate times of our lives.

We are going to put our lives in your hands.

We will trust you with our fears, hopes, wishes and plans.

I ask that you always treat patients, that you always treat US, with enthusiasm and devotion. And with care. With a lot of care. Patients, people that have a health problem, feel fragile at times. Or worried. Or alone. And the nursing staff is key for them.

Always put the patient above everything else!!

As a healthcare manager I have learned a lot over the many years I have been in healthcare, the importance of nursing within the healthcare system. Not only are people putting their health in your hands but also organizations NEED you to stay connected to the needs of the patients. You are the main asset of a healthcare organization, and in order to achieve the objective of excellent healthcare, active, well-trained and committed nursing will always be required. Due to that, ongoing training is essential and should be something that always accompanies you throughout your professional career.

You are one of the essential professions within healthcare, with a role that has gained importance in recent decades. And you are going to be protagonists in the evolution and growth of the role of nursing, due to the importance of health and well-being in the 21st century society and due to your all-round view of the patient, their emotions and their environment.

Covid-19 has been the biggest tragedy that we have faced in the last century, but I do not want it to make us forget the big challenges that you are going to face. They are challenges that are already on the table, macro trends of the system itself exacerbated by this pandemic.

And I am referring to the ageing of the population, the chronicity of illnesses, the constant appearance of new technology etc. These are challenges that are going to keep putting immense pressure on the system, to which we have to add the consequences of Covid-19, with an increase in waiting lists, late diagnosis of diseases, etc.

The Bologna convergence with the degree, Masters and PhD, the development of the specialities and advanced practice nursing, together with the boost of new graduates like you, have to be the determining elements in obtaining the degree of recognition and value that nursing deserves in the healthcare sector and society in general.

I am sure of it and of your role in the future of healthcare.

You are the best in history!

Always remember that you have received the best training, and place value on commitment, courage and an eagerness to work.

To conclude, as a father, I would like to speak to you on behalf of all of your families that, unfortunately, cannot be present today and that are following us on television or on the computer at home.

I ask that you work with passion, giving the best of yourselves.

We are very proud to see you here today, reaping the benefits of your efforts. It is such a wonderful day for you, but also know that it is for us also, your families. We have suffered when you have had problems, we have been happy with your achievements, and seeing you here today fills our hearts with joy.

We never want you to lose the enthusiasm that you have today. Your work, responsiblility, commitment and humanity are very important for the patients that you are going to treat. And also for their families.

REMEMBER THAT YOU ARE PEOPLE THAT TAKE CARE OF PEOPLE. That is my motto. Give a smile, a friendly gesture, understanding, care and respect to those around you. I assure you that they are the perfect accompaniment that will make the training you have received in this magnificent University, CEU Cardenal Herrera University, shine even brighter.

Take care of us! Of everyone! That should be the main aim of your professional life.

And I’ve come to the end, friends. Really. For me, being the KEYNOTE SPEAKER of this graduation is a “gift” that I will proudly carry with me forever wherever I go.

And I promise you that I will work so that this year of graduates has all of the possible opportunities and the visibility that you deserve. Count on me!

A hug to each and every one of you with all of my admiration, gratitude and respect.

You are now nurses!! Congratulations and get to work, we need you!!