Read the Conversation
EF: You were appointed to lead the hospital during the pandemic, what was your given mission and why did you choose Centro Medico ABC?
JMZM: The previous CEO had been leading the organization for over a decade, he had extensive experience and did an outstanding job growing and developing the organization which is both solid and strong. This gave the board the confidence to allow for a change. My background is shaped by experiences in different sectors and being at the helm of leading a healthcare group in the middle of transformational times was a big opportunity and a very interesting challenge. Since joining, I have had the opportunity to learn and transition into managing CM ABC which is well known for its excellent medical team, (physicians, nurses, operations team, etc.), it has an outstanding base and has performed with excellence developing many strengths. The board was looking for someone to facilitate its evolution towards the new normal post-Covid-19. I have, over the years, developed a specific skill set in other industries which could be of value. I felt honoured to be offered this position; it is a challenge and an opportunity to implement what I have learnt over the years while carrying out the Medical Center´s ideas, a combination that appealed to me.
When the severity of Covid-19 became apparent, the Medical Center took a courageous decision of closing half the “Observatorio” Campus and allocated all resources to support patients afflicted by Covid-19. The initial decision was taken in complete awareness of the potential financial impact it would have on the hospital showing the strong values of the organization. ABC´s first value is to support the patients in the best possible way and once the decision was taken, they prepared for the huge impact that was coming, preparing and developing infrastructure to allow for the attention of more than 140 patients –at the peak of the first wave in May/June last year. By the third quarter last year, precisely when I started working in the organization, certain decisions had been taken to focus on the attention and care of Covid-19 patients in a restricted area so that other services could also be offered in other areas of the hospital in both our campus sites: Observatorio and Santa Fe. We have very high standards in the delivery of care and we ensure health measures and standards of the highest level, guaranteeing safety demanding modified protocols to keep with the new standards. There was a decrease in patients in Santa Fe during the worst of the pandemic (May/June 2020), but by September/October 2020, we began to not only recover but recorded the highest number of operations than ever before which helped to mitigate what was going on in Observatorio. At the entrance of the second wave, in December last year, we had established a specific area that could accommodate and serve 50 Covid patients all isolated and cared for with the highest standards. In January and February, we had the challenge of working with a huge waiting list which was very hard but the board had fortunately foreseen this and created guidelines on managing the queue, a criteria to prioritize the patients according to the characteristics and symptoms and I think it worked reasonably well. Of course, one will look back and find room for improvement in the decisions that were made on the way, but I am proud as we managed very well in optimizing our resources while supporting the biggest number of patients possible. In numbers, we have done more than 30 thousand PCR tests, identified more than 3 thousand positive cases, hospitalized more than 1300 patients and developed remote services –a type of telemedicine- for communities around the country to guide and explain the different types of care which were very successful. I am very proud of the people and the institution because we performed in the way we were designed to perform.
EF: What skill set do you bring to the medical team?
JMZM: One of my biggest contributions would be my approach to improvements. My background is in engineering, I have worked in the finance sector, in telecommunications and retail in different periods, and in all the places I have worked, there have been challenges and opportunities to change or to create from scratch. I have worked on the design of a program that will allow for the alignment of the organization, for all the stakeholders of the organization to understand their role in the direction we are taking (where and why). This framework of thought and analysis is helpful given the complexity of the environment and the situation of the Medical Center. The hospital has been very successful, its qualifications, standards and certifications are excellent as is the recognition it has. But the challenges of the future require additional work within the current model as well as developing additional areas in an environment which will be deeply affected by the way third party players and patients will use the services we provide. The services will have to be integrated into an important body of physicians –private sector caregivers- to create solutions for patients and not just in a crisis mode but systematically in all the areas of the process of care. Finding common ground will allow us all to move forward delivering to the patient an effective service with quality and safety, both timely and efficient. To ensure and improve efficiency, all the groups within the organization must be aligned in discipline and understanding. To have a higher turnover in the operating rooms, for example, we need the collaboration of different groups within the hospital, we must have protocols and guidelines that will allow us to give the best care to the patients and it can’t be done by imposing directions but by collaboration. Any success I have had in the past is because I have worked with people that do what they do best and I create the environment that will allow it all to develop.
EF: If you had to design a Master in Pandemic Administration course what three subjects would you consider necessary to be included?
JMZM: First, a course that develops discerning capabilities, rational and thoughtful decisions and the capacity to challenge in a broad and smart way how things are done to be able to improve them. To acquire this skill set, people need certain tools to understand the basics, for example how a system works, something along the line of operations research is needed because that analysis gives an understanding of how things work.
Talent would also play a big part, how to manage different concerns and conflicts and the people behind them. There must be an awareness of personal development tools and management of personality, how different personalities can combine working together to develop something better.
And thirdly, information management. There are different levels in the pyramid but there must be a goal and the goal must be to create, move, and distribute that knowledge. Knowledge is an accumulation of information that has been proven to create good practices and elements for decisions so the analysis of the system, the characteristics of the people and the knowledge must be combined to create discernment.
Finally, I would also add programs to create a comprehensive plan with models that combine people to allocate resources wisely.
EF: Could you elaborate on the KPIs used in the hospital these last months?
JMZM: The set of KPIs of the medical centre is certainly impressive, especially on the clinical and safety side and even so we need to strengthen them and be assured they are complete. We use traditional KPIs of a hospital, and we are looking into enhancing those, to maximize our impact, i.e. following up the patients after 2 or 3 years -many physicians individually follow their patients but the hospital doesn’t have the integrated information. From a clinical point of view, there is indicator information (preventable infections, wrongly provided pharmaceuticals, etc.) which have a solid process of review and are very good.
We are now reviewing the patient's experience, looking for the highest standards. Coming from the retail and banking sector my standards are very high. Care of the patient is at the core of our change and a result of discipline directly related to effectiveness, safety and efficiency as I mentioned above. The organization is a non-profit one, and it is important to keep track of the efficiencies that could be achieved that can be easily overseen to invest them properly. We have different services with different complexities reflected in value but the possibility of payment is different for people from different economic statuses so value and price must be considered when attracting payers and will be a critical indicator. We are constantly seeking a better way to deliver value and ensure sustainability for the hospital and for the patients although we know we will rely on efficiency, quality. and safety. Combining all indicators with the implementation of a Balanced Scorecard, it is important to see the bigger picture, the combination of the care treatment needed, the service level and the cost, with a focus on educational activities, participation in investigation each with a specific set of indicators.
EF: How do you see the future of home care and healthcare infrastructure?
JMZM: What we saw happening last year was a pilot of what we require for these new times. At ABC, we are working in two phases, the first being to ensure strong foundations to allow for top technological solutions in a sustainable way. We must resist the temptation to jump ahead without the right foundation; we believe we have the opportunity to improve our electronic healthcare experience and our clinical management system to be the foundation for interaction with the patient. We still have to work in the prevention and physician space as it needs to be customized. We owe our patients the possibility of having a better life quality so they avoid having to come to the hospital. That process can be done in different ways, using different channels giving the patient the flexibility to choose how they want to manage the solution of their problem, for example, coming in or doing it remotely. The remote mode standards must be developed and technology and devices are paramount to achieve a precise diagnosis or that the patients’ problems are correctly understood. In order to have omnipresent health services, the evolution of the technology and the regulations are required and many different processes will have to be worked on. Over the last 6 months, we have worked with different stakeholders to rethink strategies. Telemedicine is surely something we need to push, not just what has been used for Covid but on a much broader and more ambitious level, for example, in robotics which can be done more efficiently and less invasively. It is not just a question of having the software, the system and the environment is also necessary and it might take a little more time but it will be more sustainable and allow for future growth.
EF: When you look back at your tenure, what would you like it to be remembered?
JMZM: I would be pleased if I were remembered for serving the Medical Center in its transition to a new environment and new rules, for creating the foundations for the different stakeholders to give healthcare in Mexico and for being an example to other organizations. With the talent of the physicians and the quality of the hospital, I feel proud to be part of the organization and believe we can do what we have proposed to the board.
