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Health

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)


Alberto de Rosa, English

The value of the local sphere

23 marzo, 2020 • By

It’s been one week since the government announced a state of alarm, and citizens and organisations are still struggling to adapt to these exceptional circumstances. We are all writing a line in the Story of managing this global pandemic, the first of the 21st century.

Every citizen plays their part in this situation: health professionals, pharmacists and researchers on front lines in the battle against the coronavirus; workers in basic services such as cleaning, transport, food and the security forces who help make sure that life doesn’t come to a complete halt. And our governments, each in their own area. The Central Government is trying to unify policies, collect daily information on the number of cases and give instructions and recommendations of a general nature, while regional governments, responsible for healthcare management in each territory, feed this chain of information, apply criteria coming from above and take the necessary decisions, transmitting them to the various healthcare management bodies.

I have no doubt that we’re all working along the same lines, towards maximum collaboration between institutions, with the belief that we will all win this battle together.

However, I believe that there is one player fundamental to this crisis, because of its importance as an agent of the health system and its closeness to citizens. I’m talking about city and town councils. In situations like this, the importance of municipal social services and their contact with the elderly and the most vulnerable groups at risk of exclusion, or the local police, essential to guaranteeing social isolation, is a reality that we should value at a time of maximum social tension, due to the circumstances we are facing and those that are still to come. 

And let’s not just think about the councils in big cities. The smaller the population, the more important the role of the local government due to its direct contact with citizens; they turn to it to raise doubts and concerns, and request services. These smaller municipalities often don’t have the possibility of using teleworking, which is why these public servants are also heroes during the crisis. 

At Ribera Salud we have always thought that one of our main missions as those responsible for our citizens’ healthcare is to work hand in hand with the community we serve. And to do so, there is no better formula than being fully integrated into the life of said community. We mutually support each other.

Regarding this, I am very proud as, right at the start of this health crisis, we launched an initiative to improve direct communication with local councils and to intensify coordination among all personnel. The heads of health departments managed by Ribera Salud have already held their first meetings with the mayors of all the municipalities in their areas via video conferencing. Councils as diverse as Torrevieja, Pilar de la Horadada, Orihuela, Elche, Aspe, Crevillente, Torrejón, Daganzo, and Ajalvir, among others, have participated in these coordination calls. And I would like to thank all the participating mayors for their commitment, enthusiasm and collaboration, as well as the enormous support they’ve given us over these past few days.

In these meetings, I can see four principles that I consider fundamental to healthcare management in the 21st century:

Communication between all the institutions, with the objective of always having an open channel for a quick response to an occurrence.

Transparency in explaining why decisions were made and receiving any suggestions that could help us improve and adapt to a constantly changing scenario.

Proximity, as local administrations and health departments have a higher degree of contact with citizens and are a very good source for attending to doubts and transmitting suggestions.

Coordination, because I think it is highly important that local police know the strategies of hospitals or how primary care is working first-hand, and that social services know they can receive training and information to do their job with maximum safety guarantees.

We’re all one. Each of Spain’s 8,131 city and town councils aims to work towards the general interest. For Ribera Salud, the importance of being integrated into the community where we serve goes beyond words. With these meetings we demonstrate the value of the local sphere in the global strategies of any institution or organisation through a very concrete action. Every link in the chain is important and we will continue to work along these lines. Now and forever.


English

Tripping twice (or a thousand times) on the same stone

26 febrero, 2020 • By

I have spoken several times on this blog about waiting lists, and this time I want to start with public recognition of the transparency exercise undertaken by the Generalitat. Even when the data isn’t good, there is no doubt that transparency is essential in a mature society that aspires to progress. Unlike many, I like to recognise and appreciate other people’s work when they do things right.

The publication of the waiting lists by department may have generated a certain level of controversy and debate, but these advances in transparency by the public institutions are fundamental in order to search for solutions to the problems: just like in Healthcare, when there is a clear diagnosis, the correct treatment can be applied. If you cheat at Solitaire, you’ll always be deceived.

The information made public by the Conselleria de Sanidad (Department of Health) has allowed us to learn that there are hospitals with an average waiting list of five months (154 and 140 days). And given that the average is almost half a year, that means that there are people who wait a year or more… something which is incomprehensible in the year 2020. The average waiting time in the Community of Valencia is 86 days, which is a slightly better figure in comparison to last year, which shows that, beyond the inefficient government policies, the professionals are always committed to offering good healthcare to the citizens. For them to have the necessary tools is another story. As the regional secretary stated at an appearance, “operations don’t take place in the offices, they take place in the operating theatres”. I couldn’t agree more.

However, beyond these general details, there are two points that I would like to highlight. The data provided by the Department of Health clearly reflects that the concession model significantly contributes towards the reduction of average waiting times, with tremendously favourable and positive data. I have read some comments that question these figures, coming from people that I have not seen in my day-to-day work in healthcare management during 30 years of experience in the sector, ladies and gentlemen that have never asked or learned about the reality of healthcare offered by the public-private collaboration model. In politics, as in almost all scopes of life, we must first learn the reality in order to later have a valid opinion and not just talk about what we’ve heard or follow scripts, which, by the way, are written by more people who have never seen the reality of what they are now discussing as though they are authorities on the subject.

These types of people are the ones who believe that the best way to hide the failure of their management is to question the success of others. Mediocracy is a way of life for some. What a shame.

Well, let me tell you that the Department of Health itself recognises, in this publication of waiting lists by health department, that the Ribera Salud hospitals are positioned among the top three in the Community of Valencia. That is to say, at our hospitals, citizens wait for half the amount of time than the average in hospitals in our region and up to four times less than the longest waiting lists. The numbers are stubborn.

There is another point of information that must be highlighted and that is interesting to analyse in this scope of Healthcare: the decreased quality of care at Hospital de la Ribera just 20 months after the Department of Health took over direct management. The waiting lists have moved from 57 to 78 days in less than two years, and those who wait for longer than 90 days have tripled in number, despite having hired almost 900 people. And this is only just getting started, despite the commendable work that I know the professionals at La Ribera are carrying out. The fact that something (or many things) are failing is evident.

I know that some people find it difficult to understand that it is important to have an open mind in order to seek new formulas that can help us, as a society, to improve the healthcare system and, above all, to make it sustainable over time. We must be flexible. And brave. To publish the waiting lists by department might be the first step, but bravery is necessary in order to make decisions.

If there are many indicators that clearly describe a situation, the problem is not the data but rather the underlying cause behind the data. I understand that I can get repetitive about these types of analyses, but it is necessary because sometimes we are forced to undertake positive pedagogy. When we talk about waiting lists, we’re not talking about numbers but about people.

This leads me to the appearance by the regional secretary of healthcare technology and efficiency, Concha Andrés, on February 10th, where the solution she suggested for current waiting lists was to send patients to hospitals with shorter waiting times. Given that she has not contacted either of the Ribera Salud hospitals, both positioned among the three hospitals with the shortest waiting times, I will take this opportunity to offer the healthcare clinics in our group to help them to improve the waiting times for patients in the Community of Valencia.

Cataracts, bunions, hernias and whatever is required in Traumatology, Ophthalmology, Otolaryngology or General Surgery. I’m sure that may of these ailments with the longest waiting lists are suffered by older patients, and we cannot allow political prejudice to have a negative impact on those who deserve our utmost respect for everything they have contributed, and continue to contribute, to our society.

For this reason and for the good of all of our citizens, I will never stop trying to be constructive and positive and trying to build bridges and collaborations with the public administration, always in favour of quality, efficient and sustainable healthcare.


Alberto de Rosa en ¿Qué me pasa Doctor?
English

A university, an orchestra and a hospital

26 julio, 2018 • By

An estimator from Harvard was asked: what is the most difficult thing to organise? To which he replied: there are three things that are very difficult to organise: a university, an orchestra and a hospital. The interview with Dr. Bartolome Beltrán, which took place last week on La Sexta Television, began with this visual anecdote about the main characteristic they share, all of them being multidisciplinary.READ MORE