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EF: What mission did you set for yourself when you took on the role of managing director, and how has it evolved over the past two years?
LH: My time at J&J has taught me to value the opportunity that we have to impact people. This was one of my primary motivations for taking on this role at J&J MedTech. This is an area where we can immediately see the impact that we make on the 3 to 5 million surgeries that take place every year in Spain. We need to come up with new approaches and collaborations to ensure that the quality of life for Spanish patients is improved and to ensure people have access to the treatments they need.
I took on this role as it allowed me to lead this diverse, motivated, high-quality team of people we have in Spain. Medtech is so broad that you can have many objectives and many possible priorities to go after. The role that we play in leading the team is to make sure that we focus on the things that matter, prioritize accordingly, and improve the way that we are working. For example, digitalization and the use of data are relevant externally and internally to ensure that we can become more efficient in the way that we are doing things and improve the quality of life for our employees.
EF: How is J&J's global portfolio translated into Spain, how is it evolving, and what is driving growth in Spain specifically?
LH: We have three business units: surgery, orthopedics, and cardiovascular and specialty solutions. Within each of those units, we have specific focus areas. Some of them are shared with Europe and the world, while others are more focused on Spain.
The surgery business focuses on general surgery. In line with my mission, one of the things that we try to do here is make sure that we contribute to the security and safety of patients as they go through different healthcare operations. One of the areas that we are particularly focused on is the prevention of surgical site infections. Surgical-site infections are still relevant; they have a prevalence of almost 4% in Spanish hospitals, with serious consequences for patients and the healthcare system. Several measures can be taken to reduce them, and our portfolio plays a role in this. The Spanish Society of Preventive Medicine leads an effort with several other scientific societies called Surgical Site Infection Zero. It is a series of six measures, and we are putting great effort into our collaboration with them to make a difference.
Bleeding is another area of focus for us. During surgery, bleeding occurs on a daily basis. Among the different types of bleeding, problematic bleeding is the one that needs to be addressed most immediately, interrupting the progress of the surgical procedure. Depending on the specialty, the incidence of this type of bleeding varies, reaching up to 24% in both open surgery and MIS and up to 50%, in some open procedures.
Problematic bleeding has a major impact on the patient, hospital costs, and society.
There is an opportunity to leverage adjunctive hemostats, which are products in our portfolio that help the patient with hemostasis. Despite their effectiveness, these products are not always used to their full potential, which is something we are working hard to improve.
Our third area of focus in general surgery that I would highlight is obesity. Obesity is a global pandemic. It led to four million deaths globally last year. Spain has a high incidence of obesity, at more than 18% of the adult population. There is limited access for patients to treatment measures like bariatric surgery, which we are involved in. Of the seven million potential patients, there is capability in the health system to treat only around twelve thousand cases, which is only a fraction of the need. Obesity and its related diseases are one of the future pandemics, and they account for almost 10% of the healthcare expenditure in Spain.
Obesity has a link to Type 2 diabetes, cardiovascular disease, and the development of some cancers. We are involved in tackling obesity through our portfolio and work in multi-disciplinary partnerships internally and externally with patient societies, scientific societies, and institutional stakeholders to ensure that we can come up with options and solutions to increase overall access to bariatric surgery.
The Orthopedics business is focused on trauma and orthopedic surgery. We are leading the way in trauma with the move towards pre-sterilized implant packages. Another exciting development in orthopedics is the focus on personalized medicine. It offers an opportunity to offer digital solutions and robotics for hip and knee surgery in general. That is a huge focus area for us and will be in the coming years.
Under our third business unit, cardiovascular and specialty solutions, I would like to point out atrial fibrillation. Atrial fibrillation is the most frequent arrhythmia. If treated, it is one of the most prevalent treatable causes that might lead to stroke, dementia, and other health complications. More than 1 million people in Spain are affected by this condition. More than 4% of people over 40 will need to deal with atrial fibrillation, and the incidence is increasing. Technology is improving a lot, and the standard of care has greatly improved. This is also one of the big focus areas for the future.
EF: The implementation of personalized medicine differs from a more traditional portfolio. Could you elaborate on the potential you see in personalized medicine, and how do you assess that and its receptiveness in Spain?
LH: We can look at this topic from the orthopedics point of view, which is an area where planning has been difficult. It is impactful to see an orthopedic surgeon ordering all possible sizes and options to be prepared for whatever they are going to find when they start the procedure. Patient-specific planning allows us to start with a much better idea of what the best outcome for the patient is. If we take, for example, knee replacement, we know that there is still a great deal of improvement we can make in terms of total patient satisfaction. In some studies, 20% of patients say that they are dissatisfied with their knee replacement. Up to 50% complain of anterior knee pain, and this is the most common issue. This is the result of an over-standardized approach. There is also a large amount of variability across a number of metrics.
Moving forward, a personalized approach will allow us to come up with the right option for each patient, and in knee surgery, it is mostly about alignment—patient-specific alignment. It will also reduce this variability to make sure that the vast majority of patients can benefit from whatever is considered the gold standard.
EF: How would you describe the strategic importance of Spain as a country and as a market for J&J? What is your pitch to HQ to attract resources to the country?
LH: Spain is strong on a macroeconomic level; it is the fourth-biggest economy in the European Union, and we have great economic power in general terms. The last few years have been challenging for Spain, but as a country, we have shown great resilience and found ourselves in a more favorable position than many other EU countries in terms of GDP growth and inflation. Inflation has come down significantly from where we were in 2022. Inflation is always a challenge, but it is becoming more manageable. Historically, Spain's big challenge has been unemployment rates. They have typically been much higher than in other countries, but we are seeing a good trend, with unemployment rates coming down to 12%. This is quite positive for where we came from.
If we move into the MedTech sector, we have a very high level of professionals. This can be seen in our surgeons and chiefs of surgery. There are a lot of global or regionally run and funded programs, for example, in education or investigator-driven studies, which are often awarded to Spanish institutions or Spanish doctors and surgeons. This shows that we have built up a good reputation.
Joaquin Duato, our global CEO, is Spanish and is the first non-American CEO to run Johnson & Johnson. He started his career in our offices at Johnson & Johnson Innovative Medicine, from which he went on to different countries, functions, and sectors. His story is also a strong ambassador for Spain, and it highlights the relevance of the country on a global scale.
To reach our potential, we must overcome some key challenges. In Europe, there is an issue of scarcity and a need for more medical professionals in key areas, and Spain is no exception in this area. I think one of the challenges for Spain will be that the benefits that healthcare professionals can receive by choosing to operate in other countries are significant. Although we cannot underestimate the value and quality of life, which I think are some of the reasons why so many professionals still stay, this is a structural issue that we need to continue to work on.
I think that there are big opportunities out there that we can take advantage of to further strengthen the position of Spain. The key opportunity is the European Next-Gen funds, especially the ones for recovery and resilience. A significant portion of the funds have been earmarked for Spain and will be destined for the healthcare sector. I think this is a great opportunity to invest, renew, and develop capabilities for the future.
EF: You mentioned that data was as important from an internal perspective as it was from an external perspective. Could you elaborate on that and how you are using digital technologies to enhance your operations?
LH: We sit on so much valuable data, and it is a question of how we can employ it for valuable insights. One key source of data in the company is our CRM system. We capture insights from all of the interactions that we are having at any given time with external stakeholders. We have an internal team focused on enriching the quality of data that we are putting into that system, as well as a team working with them on extracting the key insights that we need to have.
We are utilizing BI as a platform to make data more accessible. It gives all qualified parties access to the data. In the past, data was only viewed by specific groups of people. Today, every person in the company, from sales reps going out to meet customers to medical affairs, bids, and tenders, needs to look at the data before making any decisions. We are focusing on making that happen.
Another key area is intelligent automation. With the inflation and other cost impacts that we had, we needed to find ways to become more efficient. We automated about 15 end-to-end processes that translated to something like 25,000 hours annually by connecting various processes that we have in the company and making them more accessible to those who need to use them. By putting power users in each of the main departments, we can ensure that every area of the company is doing this. It does not need to be a big corporate initiative, but each department is becoming more effective and efficient.
Externally, we are collaborating on a project called IDERHA. This project is interesting because it was born out of a public-private partnership with the life science industry and the European Union. It includes 33 partners from all sorts of backgrounds, such as clinical, academic, and institutional. This project is part of the European Union's initiative: European Beating Cancer Plan, and involves generating a meta-analysis of data related to lung cancer and the prevention of lung cancer.
They are applying machine learning and artificial intelligence to create a sort of sandbox for the European Health Data Space because they are also trying to employ the rules of the future European Health Data Space to generate collective insights. This effort is aimed at increasing our success in the prevention of lung cancer or the management of the disease state of those who have it. J&J MedTech is involved in this initiative and is playing a leading role.
The Health Service of Galicia (SERGAS), the Health Service of Andalusia (SAS), and one of the leading foundations from the hospital La Fe in Valencia are participating in the project. This is an excellent example of some of the more aspirational things that we will be able to do with data. J&J Innovative Medicine has had previous types of partnerships along these lines, but it is one of our first major initiatives for MedTech.
We also made significant strides to improve colorectal cancer screening in Spain, and that was one of our core areas as this was the second leading cause of cancer deaths. Current screening approaches are an initiative of each Spanish region, and they vary. The coverage is still fairly low. However, the probability of survivorship through early diagnosis and treatment is high, and we act on it. Some years ago, J&J MedTech Spain put together an initiative with patient societies, working with leading clinicians, scientific societies, and institutional stakeholders in specific regions. We came up with a white paper of recommendations. One of the recommendations was to have the pharmacy network help provide colorectal screening kits to increase the coverage of potential patients. This initiative will be launched in the Madrid region in 2024.
EF: How do you envision a healthcare model that truly rewards outcomes? What needs to happen to get there?
LH: Value-based healthcare has been around for a long time, but it is still in its early stages in Spain. Conceptually, everyone agrees that this would be a good way to move, but there are some barriers to break down. When we are talking about value-based healthcare, we are talking about achieving the most replicable and consistent outcome for the patient while managing the cost of healthcare providers.
Firstly, we need evidence generation. We have been very focused on evidence generation and have been working on putting that into the dialogue of the healthcare system at a national level. Healthcare providers, such as hospitals, need to be able to collect and interpret data. This is one of the challenges they are currently facing, and they need to create new competencies and departments within the hospital to overcome it.
Secondly, they also need to develop, acquire, or partner with statistical expertise. Some surgeons who have done some fantastic meta-analysis have taken the initiative to go out and partner with experts in statistics. There is further opportunity for other healthcare institutions to take similar initiatives.
Having data is important, but we need to ensure that we are measuring the right things. We need to measure a holistic end-to-end patient outcome. This is probably one of the most challenging things because we need to agree on all the metrics, and we need to put them together. We also need to make sure that hospital directors consider those when they are managing the performance of their people. We need to find people who are passionate about this and want to make that extra effort, because it does take extra effort at the beginning.
Lastly, we need to make sure that there are models for value-based procurement within a public tendering model, like that of Spain. This is also challenging because the development of public tenders is not easy. Aside from working with individual hospitals and interested stakeholders to set up value-based agreements, we are partnering with the Spanish Society of Association of Hospital or Healthcare Directors, SEDISA. SEDISA is working with key institutional stakeholders from different hospitals around Spain to develop a consensus paper on value-based healthcare, how it should be set up, and specific recommendations to ensure that it can be further developed in the future. All stakeholders are trying to achieve this, but we just need to put our efforts together.
EF: As you celebrate 20 years at J&J, what achievements are you most proud of, and what moments do you reflect on that give you joy about what you have achieved?
LH: There are a few moments that I would highlight. I will pick out three outstanding moments. I started my career at J&J in marketing. Fairly quickly, I had the opportunity to assume the role of director for communication and digital for Vision Care in 2010. This was very special for me because we developed all the company's digital fundamentals. At that time, I was working in our Vision business, which has a very strong focus on the professional and the patient. Digital excellence was one of the key things at that time. I think we were a forerunner in the industry and the company for a lot of the foundational work that we did. This included the way that we trained our people, the way that we developed our infrastructure, and the way that we approached the sector.
During my time as Director of Communication for Vision, we did a lot of the key positioning campaigns. One was called Support 360, which went beyond us being a provider of products to a provider of all of the other surrounding support that we did. I think it is still a relevant concept today. My second achievement was when I went to France as General Manager for Vision Care for France, Benelux, and Iberia. That was an amazing opportunity. France was a more regulated market, and we did a lot of work with ophthalmologists to expand access. We were able to achieve some amazing results that we previously struggled to achieve in France. Leading the French business was personally gratifying. I love France, and I love my French colleagues.
The third achievement I would like to celebrate is my current work in MedTech. I think it is an incredible privilege to be able to touch so many people's lives and make a difference through our work. I am always enjoying my work, stimulated, and never bored.
