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Conversation highlights:
Hospital leadership requires balancing technical excellence with market-oriented strategy to drive sustainable transformation in Brazil's evolving healthcare landscape.
Long-term strategic planning spanning 10 years is essential for hospital transformation, as cultural change in established institutions takes time to implement effectively.
The shift from fee-for-service to value-based payment models is forcing hospitals to integrate efficiency, quality, and patient experience through digital innovation.
Staff engagement in innovation initiatives has doubled, with the most significant increase in nurses' participation with issues connected to patient assistance, developing new approaches to patient care, and operational efficiency.
China's fully integrated smart hospital model demonstrates the potential for seamless digital patient journeys from pre-admission through post-discharge care.
Brazilian hospitals must embrace risk-sharing payment models while developing capabilities to manage complex procedures across extended digital care cycles.
EF: You've been leading one of Brazil's most important private hospitals for five years now. What has been your biggest accomplishment during this period, and what's your focus for 2030?
JMDO: I was hired to drive a transformation. During my first three years, we focused on aligning hospital strategy with market trends while bringing a more systemic view to our leaders. Our hospital ranks third in Brazil and 101st internationally according to recent analysis, combining reputation, public opinion, expert assessment, and performance indicators. My major accomplishment in those first years was bringing a market-oriented perspective to an organization with exceptional technical strengths. We maintained our ranking position while continuously improving across all metrics. Managing through the later waves of COVID presented unique challenges, as we dealt with a more relaxed population seeking testing services rather than traditional inpatient care. The last two years have focused on achieving higher efficiency goals while maintaining our quality standards. We've made our negotiations with healthcare plans more objective by publishing our performance numbers and sharing our goals transparently. We also prioritized patient experience, maintaining an NPS above 81. However, at such high levels, NPS becomes less useful for improvement, so we're developing new measurement approaches. Last year, we introduced a 10-year strategic plan for the organization. This long-term planning is essential in hospitals because strategic changes take time in cultures like ours. Our institution is 128 years old, and when something has worked for so long, people question why change is necessary. We just finished doubling our emergency department capacity, a project that took nearly two years from start to finish. That's typically the horizon of a regular strategic plan, which is why we need longer-term thinking. We're positioned as the first choice in the premium segment, offering the best balance between cost and value. We're not the most expensive option, but we provide the optimal combination of quality, patient experience, and value that healthcare plans recognize.
EF: What are the key market trends you're identifying for the next five years in Brazil?
JMDO: We still need to seek efficiency, because we cannot transfer our inefficiencies to prices. Even when we negotiate well with healthcare plans, we rarely cover inflation rates. The solution lies in efficiency and innovation. Innovation must be based on digital platforms that enable integration rather than providing fragmented services. We need to see value over extended terms, moving beyond fee-for-service as the major payment model. The payment model is evolving, and we need consistent performance to support new models. Through digital platforms and the integration of vast amounts of information, we can achieve meaningful improvement. It's not about doing things faster, but doing them differently. Innovation must generate three pillars together: efficiency, quality, and patient experience. You need all three because part of the risks that used to be with healthcare plans are being transferred to providers. I don't have the business model to absorb all risks, so I need to identify which ones we can manage better and potentially earn a premium on those challenges. However, we cannot simply take risks without managing transformation.
EF: What are your expansion priorities toward 2030?
JMDO: I'm growing within the same site. We have two patient units - the major one handles 95% of activities with our emergency department, ICU, surgical rooms, and inpatient rooms. We also have an outpatient unit about 30 minutes away, but São Paulo traffic makes this challenging. The focus is on improving capacity on the same site. I can add at least 100 beds in these buildings, representing a 20-30% capacity increase. However, medical care is reducing patient stay periods, so part of our efficiency comes from reducing inpatient time while maintaining or improving quality. We can reduce hospital stays while improving quality and reducing complications, which benefits patients. We also need to engage patients in their treatment because when we share risks in new commercial models, we take on part of the risk. Patients must do their part through healthier habits, taking medications, exercising - things people like to say but don't like to do.
EF: What skill sets will the hospital of the future need from a human resources perspective?
JMDO: Change in hospital services will come not only through technology and new equipment or software, but through new ways of doing things. If we train and incentivize nurses and other professionals to be open to innovation, transformation becomes easier and faster. I just received a very good sign of this in our sixth annual innovation competition. We invite people to submit papers, ideas, or projects that are being developed or implemented. From last year to this year, we doubled the number of submissions to 220, 100% more. This happened because after finishing our strategic planning last year, we dedicated enormous energy to communicating our major messages. People wanted to show and share their ideas. We recognized leaders who submitted the most papers and proposals, and the first and second place winners were both nurses. We need to keep investing in people. We need to not only hire new competencies but also develop our own competencies. It takes time, but it's essential because it's a mistake to try to only buy solutions - you need to change and develop people.
EF: What role do you see AI playing in increasing efficiency and patient experience?
JMDO: We don't approach AI as hype. We look for opportunities to bring benefits in patient experience, efficiency, or quality of services. Most opportunities come from investments we make with AI embedded in technology. Having AI integrated in imaging equipment like CT or MR is better than managing separate systems. We're using AI to evaluate physician satisfaction through physician NPS measurement, which is a goal for us. In Brazil, we need to engage physicians to treat their patients in our hospital. We also use AI in back-office activities for revenue cycle management because it's such a long process with many variations and no standard patterns between different plans. For the future, I'm developing a framework organized around the service cycle: what we do before patients arrive, during their stay, and afterward. The hospital of the future will not be restricted to our walls. We need a digital journey that extends from complex procedures, which remain our core advantage. Through remote monitoring and digital platforms, we can do more after high-complex procedures like heart surgery, knee replacement, or oncology treatment. I'm organizing this around patient needs, professional needs, and management needs. It's a high-level framework with extensive detail underneath.
At the intersection of “Far East” and “Growth.”
EF: You recently spent two weeks in China visiting hospitals. What was your impression, and how does Brazil benchmark against what you observed?
JMDO: I visited 11 hospitals and seven companies, and they're doing exceptional work at scale. They execute what they promise. I visited hospitals following a five-year digital transformation journey - they're fully digital with everything integrated. The cell phone serves as the connecting unit between the hospital and the patient. Patients interact with the Smart Hospital Connection before arriving, creating efficiency through resource monitoring since everything is connected. You know room availability and equipment utilization in real time. The entire journey is digital, yet you still have access to professionals and physicians. They achieve more productivity without lowering standards because professionals have support, information, and integration. The next professional knows what happened with the previous one. For oncology patients with huge files, they have prompts that summarize entire histories in 30 seconds, leading to medical decision support that considers international guidelines, hospital protocols, and medical experience dynamically. In the ICU, they connect monitors with respirators and medication pumps, then apply AI to this integrated cycle. It's amazing - they've integrated everything and brought all technological advances from industry into healthcare. Once you see this level of integration, you cannot unsee it. Brazilian healthcare needs to seriously consider these approaches and the companies driving them.
EF: What should healthcare leaders prioritize when trying to match China's speed of digital integration?
JMDO: The key is not trying to match their speed directly, but understanding the right approach to integration. You need to review your own processes first, then look for tools to bring efficiency through technology integration. If you do it the other way around, it becomes expensive because you're essentially buying a tool and then looking for a problem to solve with that tool. What's impressive about China is that they are very creative, very process-oriented, and they have such a huge scale that they really need to solve problems. Otherwise, those problems become even bigger. I manage a 400-bed hospital, but China's mindset is: what if it were 5,000 beds? Would you do things differently? Probably yes. So why don't you do it now? You don't need to wait for that scale. The integration becomes viable to them based on the convergence of technologies, so they're bringing developments from other industries into healthcare.
Here is an example of this technology convergence in action: one hospital using drone technology, where a drone lands in front of the hospital to deliver medicines to another area, so patients don't need to come just to pick up drugs. Think about it: you might be able to do telemedicine, but you still make your patient drive to the hospital. What if they don't need to come at all, not even to pick up the drug? That would be better for patient experience and efficiency, because you have one less person walking around, using parking spaces.
EF: How does China's growth mindset versus Latin America's cost-driven approach differ in its impact on healthcare innovation?
JMDO: China is looking at the healthcare industry as an opportunity to keep growing because other economic cycles are closing, and they need to open new cycles to make the economy stronger. Healthcare has been exactly this focus for the last 10 years. By investing in healthcare, they provide more jobs and improve the country. They're also looking at external markets as revenue diversification, not just their local market, which is already big enough. They want to be the hub for Japan, Taiwan, and Australia. They're exporting technology globally, looking at Africa and Brazil. This growth mindset allows them to invest in solutions that might seem expensive upfront but create long-term value.
EF: What did you learn about their approach to surgical robotics during your visit?
JMDO: I visited the headquarters of a Chinese robotics company that makes surgical robots similar to the American system. They chose remote surgery as their key differentiator because it fits their country's background. They need to train surgeons far from the bigger centers to help more people. According to one expert, surgeons trained in robotic surgery take about 15 minutes to learn how the device works. It’s like renting a car abroad - everything is a little bit different in terms of size and responses, but the functions are the same. Their specific focus on remote surgery means you can have a surgeon connecting to five or six different locations per day without moving, performing operations under supervision.
Brazil faces similar challenges with huge areas and difficulty getting physicians to remote locations like the Amazon region. We see boats going up the river with technology, but in China, I saw something incredible: a plane with a full surgical room. With 5G and cellular connections, this becomes possible. These are the kinds of solutions that countries with large geographic areas need to consider. The decentralization concept has real opportunities in places like Brazil, where you have states like Mato Grosso that are difficult to reach with traditional healthcare delivery.
EF: What makes China's healthcare ecosystem so effective for rapid implementation?
JMDO: For China, it's easier because control is centralized, so they don't need to negotiate among too many stakeholders. Sometimes centralized control isn't ideal, but for these solutions, it's better. They can scale solutions because it's just transferring the same systems to new hospitals. It's not each hospital doing things its own way - it's exactly the same way everywhere. This is better for users because they know how to operate the systems, and better for the industry because they achieve scaling in solutions. It's always the same vendors supporting multiple hospitals.
EF: After seeing “the future,” what do you concentrate your priorities on? healthcare system, did you feel you needed to completely redesign your long-term strategy?
JMDO: My priority is now to design a roadmap for improvement. Seeing such a developed environment helped me build the frameworks for implementation. The frameworks are simple, even though execution isn't easy. The simplest frameworks are often the hardest to design. They're based on service cycles, so you need to map your service cycle and consider the needs of major stakeholders: patients and families, physicians, nurses, other healthcare professionals, and managers. This simple framework provides good orientation for developing the pieces needed for the roadmap.
EF: How do standardized platforms enable AI integration in Chinese hospitals?
JMDO: Based on the same platforms, it becomes viable to deploy AI agents that help on both the patient side and the physician side. Patients use digital platforms to input their symptoms, exams, and medical history, then AI navigates them through scheduling and determines what comes first, all without human interaction. Physicians receive this complete information and, based on AI, get summarized clinical histories and support for medical decisions, including international protocols, institutional protocols, and personal experience - everything integrated into their platforms.
