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The Challenge of digital transformation

22 septiembre, 2020 • By

Based on my intervention during the 1st Public Health Observatory Symposium, organised by the newspaper El Español on September 10, I would like to share some of the thoughts I was able to contribute to that interesting forum, specifically during the discussion panel dedicated to digital transformation.

When we talk about digital transformation, of the healthcare system and the challenges we face, we must make a diagnosis beyond this crisis that’s been triggered by COVID-19.

The macrotrends within the Health sector are there. We have an increasingly ageing society, and we speak about disease chronicity precisely as a result of this ageing population. There are also three other components or factors that we must know how to redirect or lead in the right direction, to ensure the sustainability and quality of our healthcare system. I’m referring to the introduction of new healthcare and information technologies, the shortage of healthcare professionals and the unsuitable training and experience of current healthcare professionals for the demands of today’s society.

Let’s start at the beginning, along the path that should guide the present and future of our Public Health. Digital transformation must become the system’s springboard.

Likewise, when we talk about our ageing population, we must tackle how we’re going to organise the social-healthcare space that has been (and still is) under so much stress during this pandemic. But we mustn’t resign ourselves to this. We must seek solutions.

Nursing homes must work more closely with the healthcare system, allowing professionals to follow up on residents, especially Primary Care professionals. There’s no need for nursing homes to turn into hospitals, but the Healthcare System must create mechanisms that will allow us to comprehensively follow up on the health of our elderly, the most fragile members of our society, and anticipate risks.

When approaching the chronicity of many diseases, largely due to this ageing population and also because of the advances in treatments, it’s essential to discuss including all the different healthcare levels: from primary care to hospital care, including social-healthcare and home care. As part of the system, we must all share a common vision and outline common strategies for action.

Because there’s no question that we’re heading towards a more predictive and preventive model. It’s important to be one step ahead of circumstances, to anticipate citizens’ health issues, to foresee the progression of their disease… In this sense, primary care must play a fundamental role within the system. Because we’re heading towards a system that, as well as healing, must also take care of and be by people’s side throughout all stages of life.

Which is the role of healthcare professionals within this new model? Through these digital transformation processes that all organisations within the sector are working on, we must disentangle the healthcare professional from more bureaucratic tasks and allow them to focus on what provides citizens with the most value, which is better care, which also entails greater satisfaction and recognition. Therefore, we must leave behind the traditional hospital concept to come home, working hand in hand with primary care, and thus see Public Health in a new light, with a more holistic approach.

To face these issues and enable new solutions, digital transformation is a fundamental platform and an ally to changing the health model, beyond COVID-19.

And these changes and the sector’s necessary evolution have a single objective: the citizens. Because people are going to play a leading role in this transformation. If someone had told us on March 1 that we’d be under lockdown, not just us but our businesses and the entire world, and that we’d be capable of adapting our organisations to working from home in less than 15 days, we wouldn’t have believed it. But we were able to do this and much more, both organisations and people. And this must give us hope, because citizens must take on the leading role in this transformation.

Some say that the population lacks digital culture… We may not know the inner workings of a mobile phone or computer, but we all know that if we want to reach a destination, know the weather forecast or stay in touch with our loved ones, our mobile phone, in short, technology, is indispensable. And that’s also digital culture. Without it, we wouldn’t have survived.

I also firmly believe that this digital transformation will empower citizens, giving them a larger role in managing their health, and making ours a more democratic, open and efficient system.

Technology also makes us more transparent, which involves trust. And digitalisation is key within the British concept of accountability, because transparency makes us more responsible.

In short, we must be capable of doing more and better things.

We can’t forget that digital transformation helps the Health system’s long-term strategies, as well as the 2030 Agenda and the Sustainable Development Goals, where goal 3 is good Health and Wellbeing. I believe that these are concepts that we, the agents that work within the system, must all strive for. In addition, goal 17 is partnerships between institutions. I’d add between public and private institutions. Because the goal is to end poverty and provide our citizens with wellbeing, and we shouldn’t place before these main goals nuances, political positions or personal whims that may become an obstacle to reaching these worldwide goals.

These days are highlighting that innovation is linked to public-private collaboration, where we find the pharmaceutical industry, big companies within the healthcare sector that participate in this symposium, and institutions. We all need to work towards common goals, discuss new relationship models between the payer, whether public (such as the State or the Autonomous Communities) or private (such as insurance companies), and suppliers of all kinds (industrial, pharmaceutical, hospital and professional) and, also, reconsider the funder’s relationship with citizens. A new relationship must arise. We must bring to the table the need to share strategies and plans, and change the relationship by moving towards shared risk models, so that we understand everyone’s mission.

Let me finish with some thoughts on this healthcare crisis brought on by COVID-19, which has already been with us for six months, and will most likely stay for some time. It has shown us that, when faced with such a crisis, we should have worked together even more, with a greater joint effort than up until now… I hope that we’ve learnt our lesson and that we’re all aware that, without bringing something to the table, without coming to an understanding, we’re going to struggle to overcome this situation, not only in the field of healthcare, but also in the social and business world. This is the greatest lesson the pandemic has taught us.


Alberto de Rosa, English

A new opportunity

1 julio, 2020 • By

We have been talking about this for many years. The post-COVID-19 reality means that it is now more necessary than ever to undergo reformations in the Health sector that will allow the system to be more flexible and provide it with the tools necessary to face health care crisis such as that we have just experienced. However, most researchers agree upon the fact that COVID-19 has been the first pandemic of the 21st century, but it will not be the last. First of all, we need to be prepared to coexist with this virus, at least until a vaccine is available on the market.

The great axes around which an urgent restructuring of the healthy system must pivot are, in my opinion: an increased Health budget, with total transparency; the introduction of reformations in the management of human resources and implementation of new organisational models, where digitalisation plays an essential role; the overcoming of barriers between levels of care, with greater integration in the social space; and the necessary involvement and collaboration of all resources in the system, both public and private.

Any type of reformation necessarily involves flexibilisation of the health system, the rigidity of which has been causing a lack of efficiency and loss of quality with regards to citizen care for decades. At a time when it is more important than ever to contribute, innovate and position ourselves one step ahead of any health care crisis that may threaten the population, the institutions must be brave and make effective decisions.

I have spoken about the necessary increase for the Health budget, of course, always from absolute transparency, prioritising resources and specifying items. But perhaps the most urgent challenge for a health system such as the Spanish one is the necessary reformation of the management of human resources, where, in my opinion, it would be advisable to redefine the legal framework in order to permit a more modern management of human resources and to introduce variable remuneration models and bonuses, in order to recognise the value provided by professionals at all times.

In the same way as the citizens have new needs with regards to the care for their well-being, I believe that it is essential to restructure the current medical specialties and to make decisions that permit an increase in the number of certain disciplines in order to adapt the offer to the demand for care. Spain is currently generating a large number of specialists that, as a consequence of the technological advances or the demographic profile of the citizens, are no longer necessary in these quantities. Even so, there is a lack of specialists in modalities where jobs for Resident Medical Interns (RMI) are not anticipated. This situation generates imbalances, rigidity in the system, low performance and, most importantly, a decrease in quality and care for citizens. Because if there is a lack of specialists, the waiting lists grow longer.

This COVID-19 crisis will imply an acceleration in the digital transformation process. It is fundamental to implement new organisational models to consolidate the general focus on digitalisation both for health care (with predictive models and online and offline care, useful healthcare websites, direct communication between the patient and their physician, promotion of home care and remote medicine, etc.) and for managing medicines (integrate complements for pharmacists in the care circuit, guarantee online prescriptions and a medicine cooperative, among others).

Another aspect to be learned from this health care crisis is that we must progress the citizen’s perspective as the protagonist of our system and overcome all barriers between the levels of care: primary care, hospital, nursing homes and specialised services. It is essential that we strengthen primary care, guarantee human resources and materials in order to offer personalised, approachable and quality care for our citizens.

It is urgent, after the devastating effect that COVID-19 has had on nursing homes, to reconsider the creation of a single socio-healthcare space in order to break the duality between Health and Social Well-being. Nursing homes must be added to the work areas that are currently integrated to the health departments.

Throughout this transformation, we must avail of all of the agents in the system, both public and private, because if there is something else that we’ve learned from this pandemic it’s that without working together and collaborating, it would have been much more difficult to provide an effective and quality response to our citizens.

I would like to dedicate this article to all of those who have lost their lives as a result of this pandemic.

(This article was published in New Medical Economics on 1sth July 2020)


Alberto de Rosa, English

Digitalisation and reindustrialisation, more lessons from this crisis

23 abril, 2020 • By

Last Friday I was interviewed on Cadena Ser by Amadeo Salvador and Arturo Blay, with whom I talked about the importance of global strategies when facing healthcare crises like COVID-19, how this worldwide emergency has proven that we need digital technology and the importance of undertaking an urgent reindustrialisation in Spain. As I have said in this interview and in similar statements that I made in the Levante-EMV newspaper and several blogposts, this worldwide pandemic has allowed us to prove that we can do many things very well without being physically present. Also, not having the resources to produce all the necessary supplies in Spain, at a time like this, has been detrimental. We should not leave two areas such as industrialisation and research completely in the hands of other countries, so that we can always have our own resources, when necessary.

– Journalist: What is the first thing that comes to mind when you realise that unfortunately in the Community of Valencia we have already had 1,000 deaths due to COVID-19?
We are facing the first pandemic of the 21st Century. And, unfortunately, I hope that we learn consequences from this new disease and the challenge we are facing for the future. But we are definitely living through a dramatic tragedy. 

– Does the fact that Germany invests three times more in healthcare than Spain have to do with their country being less affected than us?
Many conclusions must be drawn. First, it is affecting the northern hemisphere much more than the southern hemisphere. I am really worried about what is going to happen in less-developed countries when southern winter starts. This week, at Ribera Salud and in collaboration with the World Bank, we have had the opportunity to explain to 150 government, public and private institutions the experience we have had facing this situation. Because, from the point of view of solidarity and sharing knowledge, we realise that this is a global epidemic and we must respond globally and share experiences. Right now, Europe has become the epicentre of this pandemic. And, more or less, collective decisions have been made. Which I think is very important: creating this kind of collective strategies and organisations. 

Some countries have decided to perform massive testing from the beginning. Which means numbers do not add up, they have many cases but an exceptionally low mortality rate. In Spain, we may possibly have more cases than we officially recognise, precisely due to the lack of massive testing. Something that we are now trying to correct. 

– Have there been warnings in recent history? Where there precedents that could have made us suspect that this could happen?
There have been other cases of warnings by the World Health Organization with SARS, and other cases that were stopped. Because that virus did not have the same characteristics as this one. I would say that it is a virus that spreads easily. And that is something that was possibly unknown or could not have been foreseen at the beginning of the disease. Only China, the source of it, was able to contain it by isolating the entire region of Wuhan. 

But it has spread very quickly because it is easily transmitted. It also has a peculiar development, in that there are no standard parameters, or at least, to date, they are unknown. And it affects people who initially seem to have similar physical conditions very differently. Some are much more intensely affected than others. And we have cases of young people who are seriously compromised. And children are hardly affected. It has focused on adults. 

In our case, for example, we know that we are in four autonomous communities. We have seen the mortality rate of all the people that have died in our hospitals, 90% of them are over 70 years old. And, for example, 75% are men, which is also something that should be studied. 

“PUBLIC HEALTHCARE IS DEFENDED BY LISTENING TO TECHNICIANS AND EXPERTS. WITH FAST DECISIONS. NOT WITH POPULISM, SLOGANS OR IDIOMS” 

– Should national industry be strengthened so that we do not run out supplies?
In an article I wrote a few days ago, I was saying that one of the lessons we must learn from this situation is that we must strengthen global organisations. It is obvious that the virus does not distinguish between regions, borders or ideologies. If we want to provide an effective response, we must do so globally. And coordinating country strategies, especially among European countries, is essential. But we must also think about the future. For example, we must invest more in digital technology. Now we are trying out how organisations can be connected without being physically present. Investing in digital technology can be a good lesson. 

Regarding reindustrialisation, we have realised that not having solutions within the country, at a time like now, has left us at times defenceless to get essential supplies to ensure the safety of our professionals and citizens. Therefore, this service economy that we have developed has perhaps proven that, at this time, it should be reformulated in favour of reindustrialisation. 

And a third topic that I find really interesting: if we want to be a leading country, we must invest in research. And not depend on third parties, but have enough independence. These are the three lessons I think we should focus on moving forward. 

PUBLIC AND PRIVATE HEALTHCARE HAVE PROVEN THEY CAN WORK TOGETHER” 

– What do you think about the statements that have been made about public healthcare?
I feel like a manager of public healthcare and I think it must be taken seriously. I would like for the people who write headlines about public healthcare without really understanding how it works, to think more about experts and technicians for once. And less about slogans, populism, and idioms. We have a strong public healthcare in Spain because it has great professionals, who are the real heroes of this story. And within public healthcare, which we value so much now that we are in a crisis, what we can and must do is talk about how to make it more effective. I think we have proven that we must be very fast and search for very flexible formulas to be able to face a crisis. 

And if we want to be strong enough within the healthcare world to face these situations and the challenges of the 21st Century, we must not forget ageing or chronicity. And learn to combine forces… Combine the resources of the Administration, the State, the Government as well as private resources. And we must not be afraid of realising that right now we are all together. Public healthcare managed by the Government, by companies like ours and private healthcare, all working hand in hand. It is a good example for the future. The fact that we can work together towards a goal, which is to provide citizens a better service. 

– Do you think that we have taken advantage of all the elements that private healthcare can offer?

It depends on the situation. For example, in Madrid and Catalonia, where the crisis has been greater, there has been a single authority, called “Plan 102”, where public, private, and public-private resources, which is what we are, had exactly the same value. Because there was an urgent need to do so. In the Catalan system, where historically the public and state-subsidised sectors often work collectively, no issues have arisen, and they have worked well together. In the Community of Valencia, we considered the need to work together. But fortunately, the system has not become overrun as many managers feared. And the intense collaboration with the private sector that was expected has not been necessary. 

I think this is positive because it has not been necessary. But we appreciate and recognise that all the private clinics have been at the disposal of the Healthcare Department. 

MASSIVE TESTING IS ESSENTIAL. WHEN WE ARE SITTING NEXT TO EACH OTHER, WE MUST KNOW WHO HAS HAD THE DISEASE AND WHO HAS NOT TO LEAD A NORMAL LIFE” 

– What do you think about the fact that many people have stopped going to PHC clinics, or self-medicate, or A&E Departments are quite empty…?
At all our centres in the Community of Valencia we are doing many virtual consultations with other specialities. Many have preferred to stay home to follow the recommendations, because they do not want to risk becoming infected and have preferred to not come to hospital. But that does not mean that the tools are not in place. This is why I insist on investing in digital technology. We have a health portal called “Yo Salud” [My Health]. We are amazed by how its use has increased among citizens to stay in touch with hospital and PHC professionals, with a 900% increase this month. 

“OUR VIRTUAL PORTAL “YO SALUD” [MY HEALTH] HAS INCREASED ITS ACTIVITY BY 900% IN ONE MONTH” 

Before we had 100 consultations, now they have been multiplied by 9. Therefore, one lesson is that, obviously, there are serious diseases where you definitely have to go to the A&E department. But for communication about chronic diseases, going to the physician is not indispensable, although being in touch with them is. And we must promote formulas such as digitalisation. 

– Spain has a lot of fibre optics, but digitalisation is more than that, right?
These are discussions that come up in recent years. Seeing how we can improve citizen-patient communication, not only with physical visits, which are essential. But also, in cases like high blood pressure, being able to send your physician a message saying “Hey, I don’t feel well but I’ve taken my blood pressure, here are the results” and for your physician to reply… We must promote that closeness in communication and being more in contact. 

This is another challenge that the crisis is bringing to the table. And now, when they were announcing the data, I remembered something essential: the necessary relationship between the hospital and healthcare sector in general and the social sector. We have been talking about social-healthcare space for years. And perhaps this crisis has made us realise that we have focused all our attention on the healthcare sector, especially on how to strengthen hospitals to respond to this crisis. And care in nursing homes has been overlooked. Unfortunately, we are seeing tragic data. But now is the time to think about that idea of social-healthcare space. 

– Could the system collapse when this current crisis is over because of everything that is not being treated?
We are starting to look into how to set ourselves in motion again. Because we have already overcome this critical phase where it was difficult to foresee what would happen the following week, we had to be ready for the worse outcome and we have been focused on getting by day-to-day. 

Now that we are not absolutely obsessed by this, we must start thinking about what happens after the crisis. And we are working with a concept that is very important: working with the maximum safety for our professionals and our patients. Because we must move forward. And that is something that I am also insisting on many times: on doing massive testing. Because, when we are sitting next to each other, we need to know who is asymptomatic and who has had the disease to try to lead as normal a life as possible. That is why we must insist time and again on doing massive testing. 

This is the link to the full interview on Cadena Ser, in case you find it interesting: https://cadenaser.com/emisora/2020/04/17/radio_valencia/1587126029_909395.html


Alberto de Rosa, English

For a sincere collaboration

21 abril, 2020 • By

We have been under a state of alarm for over a month in response to the COVID-19 healthcare crisis, which has forced most of the population into lockdown and has ground practically the entire economy to a halt as a consequence. This decision, absolutely necessary to help curb this public health crisis, had to be taken very drastically, partly because it took so long to implement and partly because there was so much initial reluctance to the required social distancing, as I noted in my 11 March blog post. And the consequence is that this situation may now potentially go on for a long time, with the subsequent drastic impact on both the economy and society.

As I commented in last week’s post, now is the time to start looking to the future and prepare to face a new reality. How long it takes to get through this crisis is up to us and we have to put aside what separates us and focus on what unites us. Well. It seems that our leaders aren’t entirely sure about which path to follow, and even contradict each other in statements and actions, which slows down decision-making. However, I would like to positively underscore how Ximo Puig, President of the Community of Valencia, holds video conferences with business leaders and, in an “exercise in realism” about the COVID-19 crisis, publicly acknowledged that recovery is unfeasible without private initiative. Completely impossible. I’m delighted to hear it because, ever since i started posting on this blog, I have emphasised that ongoing public/private partnership is crucial, despite attacks from the usual populists.

But governments are now going to have to face a harsh reality: more than three million people affected by Temporary Redundancy Plans (ERTEs for their Spanish acronym) today, hundreds of thousands of small businesses on the brink of closing forever, tens of thousands of families who have seen their income disappear overnight, and public coffers which, already heavily indebted before the crisis, are now going to have to handle an unprecedented situation. “You have my full support (…) and within my power, we are going to support you in the projects in progress to overcome this situation”, Puig assured the entrepreneurs. It is a pleasure to hear these words from the President of the Valencian Government. As head of Ribera Salud, the company that has worked most closely with the administration, these statements give us a sense of support. 

Now it’s time to put words into action. Good intentions fall short in a national emergency like this. All of us, public institutions and private initiatives alike, must work together now more than ever before. In fact, this has always been Ribera Salud’s desire. It’s part of our DNA. This desire to serve our community, to put the public interest first and to guarantee the best health care, was the basis for the creation of Ribera Salud and the launch of Spain’s first hospital based on a unique model of public/private collaboration, the Hospital de La Ribera. 

Incidentally, two years after this collaboration ended, it has become clear that the reversal of the Hospital de Alzira has been a disaster. I’ll discuss it in depth in another post. But it’s clear: Every reality that is ignored seeks its revenge.

And returning to the public/private collaboration that President Puig noted: at Ribera Salud we have not only always defended this model but also the transparency and periodic evaluation of quality of care and healthcare outcomes. And coincidentally, the Audit Office of the Valencian Government has always valued the strength and advantages of this collaboration. The latest report on this subject has focused on the Hospital Universitario de Torrevieja, and its conclusions leave no room for doubt about its advantages. The surgical waiting list in Torrevieja is four times shorter than the average hospital in the Community of Valencia, its sound management translates into a savings of €45 million a year on public spending, 85% of its patients are very satisfied with the care they receive, and private initiative has invested €105 million in this health department to date.

Moreover, we now have to add that it is one of the hospitals that has emerged as a social leader in the fight against COVID-19 and has demonstrated the strength of the public system, contributing effectively to the recovery of many patients while providing for the safety of its professionals, and not surprisingly, it is one of the hospitals in Spain with the fewest cases of infected healthcare workers. So, yes. The Hospital de Torrevieja has also demonstrated the benefit that this public/private collaboration brings to society during a health emergency like the current one.

I’m confident that the President’s statements are more than just words and will be translated into concrete actions. And from this blog, I once again reach out to our leaders to continue working to build an excellent healthcare system in which the public system, including direct management and private collaboration, becomes increasingly stronger and seeks to join forces with others. From a place of commitment, responsibility, and serious decision-making, together we will be able to face the challenges of the 21st century and the tough times like the one we’re experiencing now.


Alberto de Rosa, English

Let’s build from a place of unity

8 abril, 2020 • By

When we celebrated the start of a new decade a little over three months ago, no one could have imagined that the 21st-century’s first pandemic was knocking on the door. It was a moment when we all wished each other health and happiness for the coming year. Health, what a beautiful word. Today we’re fighting against an enemy that is both invisible and brutal, evidenced by the deaths of tens of thousands worldwide. 

Our society has once again risen to the occasion. I believe that the people across Spain and in our Community of Valencia have given the very best of themselves. The responsibility, unity, generosity, solidarity and spirit of sacrifice of each and every one of us during this crisis and lockdown is far beyond what we could have imagined just a month ago. 

As the head of a healthcare group, Ribera Salud, I’ve had the opportunity to be on the front line of our defence. I’ve been honoured to lead an extraordinary team of professionals (physicians, nurses, assistants, technicians, administrators, guards, maintenance staff, cleaners and more) in Galicia, Madrid, Extremadura and the Community of Valencia, who have served as an incredible example of what this extraordinary profession is all about with dedication, passion, professionalism and efficiency. They have once again proved that we are an organisation of people who take care of people. And I would like to express my deep pride and appreciation for them all. 

María José, one of the amazing cleaners at our hospitals, assured us the other day that she is working “more and better than ever, because this is also my hospital and I want to help put an end to this situation”. And Cuca, an administrator at the cancer outpatient centre, told us that she didn’t want to take time off because “we’re a big family and our patients need us right now”. Emergency physician Ángel said he felt appreciated by the citizens because, “they don’t discriminate professionals by the type of hospital in which they work, despite the efforts of some politicians”. They insist they’re not special, but their values are an example for us all. There you have it.

I would also like to thank the overwhelming demonstrations of kindness and solidarity from individuals, groups and companies who are helping to make this situation more bearable with their donations and displays of support for professionals. And, of course, the security forces for their impressive public service efforts, whatever the job they are assigned. We also try to stay in close contact with both local and regional institutions to keep them up to date with the evolution of the crisis. Because information and transparency are the cornerstones of teamwork.

Now is the time to start looking to the future and prepare to face a new reality. The damage this pandemic will have on public services, social habits, and the economy will be severe. And once again, how long it takes to get through it is up to us. We need to put an end to divisive debates and to encourage all those things that unite us. This pandemic knows no borders, social classes, or political ideologies. And questioning globalisation and advocating for archaic nationalism is misguided, because the virus has also taught us that this fight requires a global response.

It is tempting to offer simple, populist responses to complex scenarios, but that would be wrong. When it comes to healthcare, I hear confrontational messages about public vs, private, when the response to the crisis would have been a complete disaster without the collaboration between both sectors. Simply impossible. 

When it comes to the economy, I hear criticism of people like Amancio Ortega and Juan Roig, when they’ve served as examples of commitment and generosity and stand as true social leaders. Meanwhile, in politics, different leaders make decisions based on what they think will best serve their position in the short term. 

And that’s not what the virus is about. It’s about changing our priorities and social values. About seeking consensus and compromise, joining forces. About generosity, listening, being thankful. Ultimately, it’s a lesson in humility. Our political leaders have the opportunity to take on this challenge with all the power and vision of the State. I don’t know if they will. But I would ask them to keep in mind the elderly who have died in nursing homes when they make their decisions, because they were not given the priority care they deserved. And the overwhelming number of professionals infected because the government failed to provide enough PPE. Professionals who went to work every day, despite their fears, to fight for all of us. Which is why I’d like to take this opportunity to thank the team at the Ribera Salud purchasing department for their dedication and efficiency in helping to prevent the spread of the virus among our professionals. 

Let’s hope that all those responsible for moving our nation forward will live up to the example set by the country’s citizens. 

(This article was published in the newspaper Levante-EMV on 7th April 2020)