What we can do to stay healthy and liver longer

What we can do to stay healthy and liver longer

Posted by on Jul 10, 2018 | No Comments

Since all of us at Diaverum are focusing on the wellbeing of our close to 35 000 patients around the world, it is sometimes worthwhile to stop and think about how we can stay healthy. Life is short and we all want to have as long and healthy a life as possible. Wherever I travel in the world I see a lot of people who are out of shape, weigh far too much and have little energy.

The question is what we can do ourselves to stay healthy and thereby live longer.

As always there is no single factor but rather a combination of factors which contribute to increasing the likelihood of staying healthy. When it comes to eating, we all know that obesity is an enormous problem in many countries around the world. Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer.

According to WHO, the prevalence of obesity among adults (obesity defined as BMI of 30 or higher) has increased globally from 10.7% in 2008 to 13.1% in 2016. There are today a number of countries with a prevalence of more than 30%: USA, Saudi Arabia, Qatar, UAE, Libya, Egypt, Jordan, Lebanon, Turkey, New Zealand and Israel. A large number of countries are very close to the 30% mark.

When it comes to eating, volumes of books have been written about diets. Seemingly, just after everyone rushes to try these diets, someone issues a study saying that the diet does not work or is not very healthy. Very frustrating indeed.

I believe in “moderation”. Not to “over-eat” and to eat a variety of foods. The only way to lose weight is to eat fewer calories than one burns. There is no miracle cure! Every time I need to lose a few kilos, I start eating less. That is normally enough to lose some weight.

As regards exercising, volumes of books have also been written about various exercise regimes. The key thing is to move. Walking, as an example, strengthens our hearts, increases bone density and builds endurance.

Taking 10,000 daily steps means one has walked about five miles or 9 kilometers. Many people do not get close to reaching this goal, which is why fitness trackers can be so useful. According to the UK’s National Health Service (NHS), the average person only walks between 3,000 and 4,000 steps per day.

Sleep is also important. Sleep is the time when our body recovers and when our immune systems are improved. A study conducted by the American Cancer Society concluded that people who sleep less than 6 or more than 9 hours per night had a death rate 30% higher than those who regularly slept 7 to 8 hours.

So, the conclusion is: we all need to eat sensibly, exercise regularly and sleep 7 to 9 hours per night. This will increase the likelihood of living a healthier life.


Creating a culture of innovation

Creating a culture of innovation

Posted by on May 28, 2018 | No Comments

I have been participating in a couple of interesting meetings and conferences over the last few weeks. In Sweden, the Saudi Sweden Joint Business Council (where Diaverum is a member) met early May. I participated in a panel debate about “creating a culture of innovation in healthcare”. In my introduction, I talked briefly about the global trends in healthcare. As we all know healthcare is already today facing and will continue to face 3 major challenges;

  • Patients
    There will be a “tsunami” of patients. The global population increases by approximately 80 million each year and the population is rapidly ageing. Many patients will suffer from chronic diseases and very often from more than one chronic disease. Patients are also expecting more from healthcare delivery and one real challenge is that most health systems are stuck in an old model of provision.
  • Staff
    There is an increasing shortage of healthcare professionals around the world. There is simply not enough interest in becoming a healthcare professional. In many countries there are more nurses leaving than entering the work force. There is today a global shortage of healthcare workers of 7.2m, this is projected to grow to 12.9m by 2035.
  • Costs
    75% of healthcare spend in Western World is on chronic disease management. As the number of patients with chronic diseases increases, the pressure on public finances grows. In many countries healthcare spend continues to outstrip GDP growth. This is of course not sustainable.

Innovative care models

With the shortage of healthcare professionals, combined with the escalation of number of patients and increased focus on chronic disease management it is clear that we will have to find ways to ensure improved patient outcomes and patient experience using less resources. This is of course a major challenge but I am sure that technology combined with innovation and digitalization will support this ambition.

Changing the care model is not a “quick fix” and will require significant investments in IT and it is also clear that there will be not only one care model for kidney patients. We will continue to work with different models in different countries even if I believe that care models will become more aligned over time.

The healthcare service companies which manage to improve patient outcomes and patient experiences at the same time as they manage to reduce overall cost to serve will be the winning companies in the future. As I said above, healthcare spend cannot continue to escalate in the same way as has been the case in the past.

In year 2016, the US spent nearly 18% of its GDP on health, whereas the next highest comparable country (Switzerland) devoted less than 13% of its GDP to health. Average in Europe is just below 10%.

A big thank you to all nurses

A big thank you to all nurses

Posted by on May 12, 2016 | No Comments

Today is International Nurses Day and I would like to express my deepest thanks to all nurses worldwide who have chosen this incredibly important job. I can only speak for the nurses that we work with in Diaverum, but their professionalism, dedication and enthusiasm impresses me every day. Only due to their care and attention can Diaverum patients worldwide live a fuller life despite having to undergo dialysis treatment three times per week. This special care and attention goes far beyond the medical treatment: it is the smile that welcomes the patients when entering the treatment room, the effort put into making the stay in the dialysis clinic as comfortable as possible and the commitment to improving the quality of life for their patients, for example by organising a revitalising vacation for them. Most nurses build lasting relationships and even friendships with our patients and they are just as excited as the patients themselves when they are, for example, chosen for a kidney transplant. In those moments this job is certainly rewarding, but very often it is very challenging and this earns my full and genuine respect. Thank you!


The patient’s view

The patient’s view

Posted by on Apr 29, 2016 | No Comments

I have just travelled back from Diaverum’s annual meeting. This year the meeting took place in Cascais (Portugal), where over 200 managers met to learn and share experience from colleagues representing our 20 countries around the world. This year we had the honour to listen to one of our patients from Australia, Greg Collette. With 20 years on dialysis he had a lot of important messages to share with the audience. To regularly listen to our patients is the only way to really improve their quality of life for renal patients. Greg Collette, who also writes his own blog at bigdandme.wordpress.com, and he spoke about what is key for a patient, who is about to choose a kidney centre for his or her treatment. He talked about the importance of feeling safe and comfortable, having flexibility with regards to treatment time (especially for patients who work), good food and the proximity to home. Whilst we should know all this as people working every day with renal patients, it was good to hear it from an experienced patient.

Greg also talked about the need to receive more personalised care and the possibility for patients to play a larger role in their health management.  He is very engaged in supporting other patients and has for example been an active developer of our d.CARE app. One very important comment he made in his talk is the active inclusion of patient representatives in the management team meetings in the countries. I found this an excellent idea and I can only encourage all people working in healthcare to do that on a regular basis: To invite patients to really understand how they think and feel about their disease and their treatment. This is essential to improve their quality of life.

Public Private Partnership (PPP) in Health Care

Public Private Partnership (PPP) in Health Care

Posted by on Mar 16, 2016 | No Comments

Earlier this month I participated as a speaker on a panel at the Jeddah Economic Forum. The Forum was first held in 1999 and since then has become an annual event where government leaders, business executives, and leading thinkers come together to discuss solutions to regional and international social and economic challenges.

This year the main theme was centered on public private partnerships. In many countries there is a wave of outsourcing from public to private. Private providers are many times more efficient and provide better services than the public sector. In the panel I participated on, the focus was on PPP in the health care sector.
Privatization has proven to be a highly efficient measure to bring healthcare to remote areas of Saudi Arabia, thus improving the availability and quality of state-of-the-art services for the benefit of patients. In 2013, my company Diaverum was awarded a five-year contract from the Ministry of Health to care for 5,000 renal patients across the country and has since opened 15 clinics. Another 15 are planned to open this year.

It is estimated that nearly 10 per cent of the Saudi population suffer from Chronic Kidney Disease, which may ultimately lead to a need for regular dialysis treatment and is a serious condition that requires modern technology and specialist care. On average, the number of dialysis patients in the Kingdom is growing by 10 per cent per year. This is primarily triggered by diabetes and hypertension.

We work in partnership with the public sector in many countries around the world; UK, Australia, Spain and Sweden – just to name a few examples of close cooperation with the public sector. To be successful in a PPP health care environment it is important that one truly creates value for both patients and the health care systems. In our case it is about proving that we can deliver the highest possible medical outcomes, based on agreed measures and targets (agreement between the provider and the outsourcing body).

In the case of Saudi, there are 5 key areas that we deliver on in our PPP with the Ministry of Health;
One key area is to secure access for all patients in need of renal care. Patients do not want to travel further than necessary and they do not want to wait for their treatment. One of the major issues for patients all around the world is waiting time before the treatment.

The second key area relates to facility management and infection control. It is important to construct the clinics in such a way that they provide the most modern layout and equipment. Not only to ensure state of the art, but also to prevent cross contamination of infectious diseases.

The third area relates to training. To be able to increase the knowledge and professionalism, a strong focus must be put on education. This is one strong reason for choosing a private provider who has a global educational program in place for doctors, nurses and patients.

The fourth area is medical outcome and preventive care. To define ambitious medical targets and to follow up/communicate regularly is absolutely key for success in a PPP environment. With regards to preventive care, our ambition is to delay the entry into dialysis for our patients. Our nephrologists (doctors) are experts on all stages of CKD and can help to slow the down the progression of the illness by treatment and patient training. It is our strong belief that the patients who respond best to treatments are those who are well informed and well prepared. This is why early detection of chronic kidney disease is so important.

Last but not least – Productivity and efficiency. One advantage of partnering with a global private provider is ability to source consumables and equipment at competitive prices. The larger the volume, the better the prices. From an efficiency perspective, the provider is the one investing in buildings and equipment. The public sector thus avoids this financial commitment.

What is important, particularly in relation to the last key area is the contract time. To have a long enough PPP contract is necessary in order to recover some of the investments in the facilities. In most cases our contracts are valid for 8-10 years before a retender takes place.

The concept of Integration Nurses

Posted by on Nov 17, 2015 | No Comments

Integration is derived from the Latin integrare, which means renew, amend, mentally refresh. This is exactly what Diaverum is doing with the concept of the Integration Nurses. We are sending experienced nurses from our existing markets to the new markets where we are opening up new clinics. By doing so, Diaverum is renewing the local knowhow, amending processes and policies if required and refreshing the knowledge — all in the interest of the patients.

I believe this is a win-win situation: renal nurses who are interested in experiencing another culture for a certain period of time can do so without risking their job “at home” and they really see the impact they are having on the health and well-being of the patients by introducing our globally recognized policies and procedures. On the other hand, the newly established clinics gain a lot of knowhow and experience from the Integration Nurses. The double-edged experience can be as ‘broad’ as a Portuguese nurse going to Saudi Arabia or as ‘close’ as Turkish nurses spending a few months working in Kazakhstan. The Integration Nurses are the link between management, medical and operation teams and the new nurses recruited in a given country. An excellent interpretation of ‘integration’ in my opinion.

Impressions from our clinics in Kazakhstan

Posted by on Oct 9, 2015 | No Comments

A few weeks ago, I had the opportunity to visit one of our clinics in Almaty, Kazakhstan. Almaty is the largest city in the country but not the capital city (Astana is the capital). I had the chance to spend time with patients and staff in the clinic and I could see the improvements taking place since we acquired the clinic at the beginning of the year. Medical performance has clearly improved, the patients are more satisfied and the staff also sees the benefit of working for a global healthcare provider with a clear focus on the patient and the care provided.

Kazakhstan is one of the largest countries in the world, but has only 17.5 million inhabitants. With a land area of 2.7 million m² the population density is one of the lowest in the world. ESRD (end stage renal disease) prevalence is also very low: 225 per million inhabitants. There are today 4,100 patients in the country and this number is growing at double digit rate every year. The increasing patient numbers also pose another challenge: there are too few nephrologists in the country, too few to even care for the existing number of patients. Why is that the case? Is the role of a nephrologist not attractive in Kazakhstan and what can we do to change that? We might want to look into other countries, learn from their experiences and adapt those models to Kazakhstan, to ensure that the renal patients continue to receive the best treatment from trained nephrologists.

Innovations down under

Posted by on Sep 15, 2015 | No Comments

I am back from vacation and many of my colleagues in Europe have either had their summer vacations or are starting vacations now. It is important to get some rest and to recharge one’s batteries and also to be able to spend some time with family and friends. But even if Europeans have been on holiday, activity levels in Diaverum, the company that I am heading, has been very high. We have just opened our second clinic in the capital of Australia, Canberra. By doing so, we are bringing care closer to the patients – which is, especially in a country the size of Australia, quite a challenge. We are using innovative technologies to reach the patients that are living far away from a dialysis centre, for example with our d.CARE App. Whilst apps themselves are not really innovative anymore, apps in the healthcare sector still are a rarity. The challenge is adhering to data security regulations, which are different in each country, whilst responding to the patients’ needs to get access to their data – to be able to take an active role in their health. Innovations are crucial in the healthcare market and we will continue to explore innovations related to apps, telemedicine, etc. These innovations can improve quality of life for the patients which is the ultimate goal of all the activities we undertake. The d.CARE App is improving the quality of life for the patients in Australia, which was selected as the pilot country. We are now looking forward to rolling the App out in more countries to more patients shortly. Maybe one of these countries will even be New Zealand, where we will open our first clinic during early 2016.


Posted by on Jun 19, 2015 | No Comments

We did not have the best of springs this year in Sweden and the summer started rather wet and cold, particularly May which was the wettest for many years. Nevertheless, Sweden is gearing up to celebrate Midsummer this evening (June 19) and, as the weather has improved over the last few days, I am looking forward to a very nice evening.

We have long and dark winters in Sweden and therefore Midsummer is something we truly appreciate. In the north of Sweden there is 24-hour daylight at this time of the year and in the south of Sweden the sun sets for only a few hours.  The typical tradition in Sweden during Midsummer is to build a midsummer pole and dance around this pole before sitting down for a long dinner with herring, a traditional liqueur and a lot of singing.

After Midsummer many Swedes start taking their summer vacations. It is quite customary for people to take a couple of weeks’ vacation in a row. Leading a global company makes it impossible in my case to take a long holiday, but midsummer always marks an important milestone and provides a short break. And I try to take at least two weeks’ vacation during the summer. This helps me to recharge my batteries and arrive back in the office feeling ‘revitalised’ and ready to continue leading the company towards our defined goals.

Tonight, however, I am happy to be with my family and happy to celebrate Midsummer — one of the most important Swedish traditions.

Same same but different: healthcare business in different cultures

Posted by on May 29, 2015 | No Comments

At a VIP dinner hosted by Diaverum in London yesterday evening, I had the opportunity to meet with almost 20 leading nephrologists and renal business partners from 10 different countries. An exciting experience, since such dinners provide the opportunity to learn about the local challenges and to discuss areas of improvement in the care of our patients. Each country has a different healthcare environment with different reimbursement levels and local regulations but the ultimate goal is (or at least should be) to provide the best possible quality of care for patients.

Being Swedish certainly helps in many ways – Swedes have for many decades been used to working in different markets and cultures. Sweden is a small country and was forced already in the early 20th century to look outward rather than inward and many of our successful companies today were therefore established many decades ago. In my experience the best strategy for a multinational business is a ´global but local´ approach. In most cases it is neither possible nor reasonable to try to roll out a global approach in all countries. When it comes to medical policies and procedures Diaverum is very strict in implementing the highest global standards in any market that we operate in. But, when it comes to company culture, it is essential to adapt to local cultures. And this is what ultimately makes a company successful.

For Europeans, the Middle East is a rather unknown part of the world. Visiting Dubai for a couple of days´ holiday does not mean that one has learnt the culture of the region. Even if cultures in the countries forming the Middle East are very different to the cultures in Sweden or in other European countries there is one thing that truly unites us. We all strive for putting the patient in the centre.

I have had the opportunity to visit a few of Diaverum’s kidney centres in Saudi Arabia and the passion and patient-centred approach displayed by our staff is very encouraging. There is also a genuine politeness and respect towards our patients. I would go as far as to say that countries in many other parts of the world can learn from the patient-centred culture in Saudi Arabia.

Foto på Dag Andersson