“The Fight Against Covid-19 Is a Challenge of Our Generation.”
Interview with with Alberto de Rosa, CEO of Ribera Salud
Ribera Salud Group, a leading integrated health care provider in Spain, had little time to prepare for the devastating onslaught of Covid-19. Capacity in their six hospitals had to be expanded rapidly to manage the sudden flow of ill patients, while staff had to be trained in how to treat highly infectious patients without spreading the disease further. Ribera Salud’s CEO, Alberto de Rosa, recently joined a webinar sponsored by IFC’s Health Quality Team to talk about what the hospital did to manage care in times of crisis.
How quickly did you have to increase capacity in response to Covid?
Things moved very fast. At the beginning of March, in our University Hospital of Torrejón in Madrid we had just nine Covid patients in the wards and three in intensive care. By early April, we had 237 in the wards and 23 in intensive care. The wave of infections in Spain hit Madrid a couple of weeks before the rest of the country, so our hospital in Madrid had to prepare very quickly. Over 80 percent of hospital beds were occupied by Covid patients. In Madrid, which was the epicenter of Spain’s outbreak, almost 100 percent were Covid patients which meant, for example, that we had to move the pediatrics wing to other hospitals. In total, we had to double capacity inside our hospitals.
What were the steps you took to protect patients and staff?
Firstly, we provided information and training about Covid—how it is transmitted and how not to catch it or transmit it. Then we put in place training protocols on how to use individual pieces of equipment and how to handle positive or suspicious cases. It is important to continually keep the training and information up to date.
Secondly, for clinical staff who were treating Covid patients, we assigned them exclusively to those patients to avoid cross-infection.
Thirdly, we recruited additional, experienced staff to work in our hospitalization and intensive care units and we reallocated staff from other specialties to work in intensive care. With personal protective equipment, we created a four-level system for determining what individual staff members must wear based on their level of risk exposure.
And finally, we have split the hospital into two different facilities with different spaces, protocols, and operations. One treats Covid-19 patients, the other is Covid-free and operates normal activity.
How did you harness IT and technology?
We saw Covid as both a crisis and an opportunity to accelerate some things we should already have been doing. Telemedicine is a good example. We used to do about 50 percent of elective health care completely digitally. That share has risen to about 75 percent. This means that each week we exchange about five million secure electronic messages between patients, citizens, and professionals, both at hospital and primary care level. Secondly, we enabled non-core services of the hospital such as procurement, finance, and management to operate remotely from home. To do that you need to establish appropriate policies, training, and licensing. At the same time, you must increase the help desk capacity and support to facilitate all these new connections. Getting the right cyber security tools is very important too. In Europe there has been a 200 percent increase in cyber-attacks since the Covid crisis.
Have you any specific recommendation for health care organizations in emerging markets as they face the pandemic?
We try to buy protective personal equipment supplies well in advance. It is very difficult to buy and organize everything. Conserve materials as much as possible through measures such as placing all Covid patients in the same area. To procure materials from the market, it may be easier to partner with other organizations to make a high-volume purchase.
It is important to develop a specific plan for the community, particularly for nursing homes. This pandemic has taught us that elderly people are vulnerable; they are an at-risk group and the number one target of the virus.
Programs to develop home-based care are also essential—this is how we avoided the collapse of the system.
What overall lessons or messages do you wish to share from this experience?
The fight against Covid-19 is a challenge of our generation. This pandemic is global so we must give a global answer, collaborate, and learn from different countries’ experiences. Firstly, bear in mind that in a crisis, where so much is new and unknown, plans last only one week. You need to be flexible to adapt to a fast-evolving situation. Secondly, it is crucial to work to get one step ahead of Covid-19. Fast and powerful internal communication is essential, as is continuous analysis and developing models for predicting different scenarios. Finally, the organization must be led by a clinical vision and strategy. Other departments—technology, purchasing, general services—must support the clinicians to act effectively.
With more than 30 years of experience in hospital management, Alberto de Rosa has been CEO of Ribera Salud Group since 2013, having joined in 2007 as General Manager. In 1998 De Rosa was appointed Managing Director of the Hospital of La Ribera de Alzira (Valencia), the first privately managed public hospital in Spain. He holds a degree in Economics and Business Administration from the University of Valencia, an MBA from ESADE Business School in Barcelona, and a Master’s in Higher Health Management.