Case Study

Grupo Conclina

May 25, 2021

The largest private hospital in Ecuador, Hospital Metropolitano in Quito, also has one of the strongest reputations for quality of care. This is not an accident; the company’s culture and day-to-day practices have been shaped by three major choices that its leaders have made through its history.

The first was to establish governance structures dedicated to quality of care. The hospital was conceived in 1977 by a group of Ecuadorian physicians who had been trained in the United States and Europe. They wanted to bring international standards to a hospital in their country. Javier Contreras, currently the CEO of the hospital and its parent company, Grupo Conclina, describes their ambitions as follows: “We want to lead the healthcare transformation in our country.  ” They ultimately set up a structure where the majority shareholder is a healthcare non-profit, the Metrofraternidad Foundation.

The second choice was to establish a business model that would give Grupo Conclina the financial resilience it would need to fulfill its long-term goals. In 2000, the group acquired Humana S.A., a prepaid healthcare plan with about 215,000 members. As with Kaiser-Permanente in the United States, this business model involves pairing the payor service with the group’s hospital and outpatient services—in effect, a complementary source of revenue and a way to broaden the group’s value to people in and around Quito.

The third choice was to take on the challenge of meeting international standards for quality healthcare and wellness. In 2011, Hospital Metropolitano became the only hospital in Ecuador accredited by the Joint Commission International (JCI), a global healthcare certification body. It generally takes several years for a hospital to gain the technical and procedural excellence to meet JCI’s standards. Having gained this certification, Conclina is now going a step further; it’s midway through a similar process with the Planetree medical organization, whose standards focus on person-centered care and wellness.

All three of these decisions became, in effect, forcing functions moving the company continually toward higher quality and a warmer, more patient-supportive atmosphere  . The value of this approach became evident when the pandemic struck. Ecuador has been considered one of the worst-hit countries, in terms of health and economic impact. Like all healthcare organizations, Hospital Metropolitano was rapidly thrown into turmoil; to recover, they had to show their patients and their government that they could treat people when the world was shutting down. And they had to provide employees with assurance that they had a steady place to work—as professionals on whose skills many others would rely.

The Grupo Conclina story is one of effectiveness during the pandemic because of capabilities built up over the years before. The story also shows how financing can be of most value to a healthcare business in emerging economies: when it is flexible and oriented toward long-term viability.




I. Create structures that stand for the hospital’s aspirations

The culture of the enterprise reflects its governance model

II. Instill formal practices to create a healthy culture

Collaboration and accreditation can foster a quality ethic

III. Design a diversified business model that allows for growth

A leading role in the community requires a profitable business

IV. In crisis, build on your strengths and seek flexibility

Covid-19 is testing the commitment and resilience of organizations like Grupo Conclina


The leaders of Grupo Conclina are preparing for change after the pandemic. They are contemplating expansion, potentially into new geographies within Ecuador, and preparing to offer new healthcare services. Grupo Conclina has most recovered from the financial difficulties of the early pandemic. It did not recoup the losses from direct hospital revenue, but its payor business, Humana S.A., saw medical claims drop as people put off non-COVID treatments, and that led to a short-term rise in profits. As vaccines become available and the pandemic evolves to a less virulent phase, these structural factors may change as well. The greatest asset Grupo Conclina has is the embedded resilience that it has gained from its three forcing functions: the governance structure that reinforces quality, the business model that combines provider and payor revenues, and the willingness to embrace a high level of discipline and quality, as judged by global standards.

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