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!
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.
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.
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.
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.
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.
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.
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.
As CEO, my task is to lead the company into the future. No matter how long one has been in business, one can never rest on ones laurels for too long. Securing the future is the main responsibility of any CEO. Quite often I think about what success really means and how it can be used to influence. There are many books about this topic but you can only really understand it when looking at reality. Here is a current case that serves as a good example to me.
A few weeks ago I joined the official inauguration of our four new renal centres in Birmingham, UK and it was one of the days that made me feel very proud. Our UK team had transferred 450 patients to four newly built dialysis centres in the course of only one day — a mammoth task that ended very successfully thanks to great support from colleagues from different parts of the world who travelled to Birmingham to be part of this team effort.
Talking to our patients and our staff in the new clinics it was clear that the secret behind this success story was the fact that we listened to the needs of our patients. The team only had a few months to prepare the move, but during that time they were in a constant dialogue with their future patients and also future members of staff. They asked the patients questions such as “What is important for you to feel secure in the clinic?”, “What makes it a revitalising experience?”, “ How do you want to work in the new environment?” The UK team then frequently showed what the patients asked for (“you said”) and how Diaverum turned these ideas around (“we did”). And this approach — you said, we did — paid off resulting in highly satisfied patients that put their trust in Diaverum from day one and motivated employees delivering the best service to the patients. We managed to create a win-win situation and a successful base in Birmingham from which we will continue to grow the business and secure strong financial performance as a consequence of working closely with patients and staff to deliver the very best patient care and work environment.
That is an example of what success means for me.
Predicting the future is almost impossible and it takes strong, firm leadership to turn challenges into opportunities.
When I did my MBA at INSEAD many years ago, one of my professors told me that the only way to predict the future is by looking at the past — there is no such thing as a crystal ball which tells the future.
This might sound a little simplistic and maybe even brutal but this is the way things are.
Take trying to predict currency movements, stock market development, economic cycles, for example: all predictions are simply assumptions and these assumptions are typically based on past experience.
The likelihood is that someone will guess correctly but this is down to luck and experience rather than an ability to look into the future.
Who could foresee the economic meltdown in the Eurozone starting in 2008? Who would predict that the euro as a currency would come under threat? Who could predict that oil prices would plunge the way they have done lately? Who could predict that the tension in Russia and Ukraine would bring us back to the ‘Cold War sentiment’ where Russia once more was cast as the enemy?
Since nobody can predict the future it is important to listen to the views of many different people.
When running a global healthcare services company with presence in 18 countries, the only thing that is (almost) certain is that there will be macroeconomic challenges in one or a few of these countries at any given time. We have seen the Russian rouble, Argentinian peso and Turkish lira plunge during the year; we have seen signs of recovery in Spain and Portugal; and we have seen the impact the falling oil price has had on the economies of Saudi Arabia and Russia.
What will happen in 2015 which we are not able to predict today? Will there be a sustainable economic recovery in Europe in 2015? Probably not. Will oil prices increase again to 100-plus dollars per barrel? Probably not. Will the situation in Syria and Iraq improve or will IS continue to seize more territory? Probably yes.
Will something significant happen in the world in 2015 which we cannot predict today? Definitely yes.
What are the implications for business in all this uncertainty? One thing which I always have believed in and which is going to be important for the foreseeable future is to manage cash flow as well as one possible can. Cash is king (or queen). This is for any company the most important measure of financial success. A company with strong cash flow will always fare better than a company not focusing strongly on cash flow.
I believe that any company today also needs to have mitigation plans ready to be implemented in case country performance is much lower than planned. To sit back and accept that performance goes down without implementing strong measures is nothing that shareholders or private equity owners appreciate. What we know is that shocks to the system do happen much quicker today than before due to increased volatility and shorter cycles. Therefore any successful organisation must always be prepared to mitigate, face the problem and turn it into an opportunity.
Strong leadership from the top is a prerequisite for success. Management by objectives and delegation is something I have practiced in all leading positions I have had, but one must always keep a firm hand on the steering wheel and be prepared to act quickly whenever things do go wrong. And the only thing we can be certain about is that things will go wrong. The only question is where, when and what the magnitude will be. Being prepared will help you turn these challenges into an opportunity and come out as a winner! There will be many losers in tomorrow’s world and a few winners. Which category do you want to belong to?