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!

#InternationalNurseDay

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.

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.

Future challenges require firm leadership

Posted by: on Dec 12, 2014 | No Comments

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?

Going evermore global

Posted by: on Aug 5, 2014 | No Comments

This summer has so far been absolutely wonderful in Sweden. I have never experienced so many sunny, warm days in my life (at least from what I remember). Day temperatures of 30 degrees or even more; night time temperatures of 20 degrees or more. Apparently a ‘tropical’ night is defined as a night when temperatures do not fall below 20 degrees, and there have been quite a few of these nights this year in Sweden.

As many of you know, I am now based in Sweden and spend a large part of my time commuting to the corporate office in Munich or beyond. My wife and daughter wanted to move back to Sweden again after five years in Munich. My daughter wanted to go to a ‘normal’ Swedish school in the area where we live just outside Gothenburg. My wife wanted to get closer to her parents who are getting older and wanted to see their only child on a more regular basis. Therefore we moved back last summer to Gothenburg. I do believe there was initial angst amongst the Diaverum people in the Munich corporate office that I would not spend much time in Munich anymore but I believe I have proven people wrong. But as the company continues to grow and enters new markets, there is more need for me to be travelling around the world. This means spending less time in Munich (and in Sweden).

We are growing very fast as a company. By the end of this year we will be 9000 employees and present in 20 or 21 countries. As far as I know, there is no other healthcare service provider in the world with a more global direct presence than Diaverum. I obviously do not include product manufacturers in this statement, only 100% service only providers. Renal care is a rather standardised segment within healthcare and therefore easier to globalise than, for example, acute care. A renal patient has the same overall needs whether he is a patient in Sweden, UK, Russia or Uruguay. Therefore there are clear economies of scale and scope when entering new markets.

One of the challenges when entering a new market is to find the right people to recruit (management and clinic staff). Typically we enter a new market by acquiring one clinic or a few clinics belonging to a private owner. Finding an excellent Country Manager or Finance Director for a small business is naturally a challenge. Excellent people do typically already have a job and they are seldom prepared to move to a smaller company or business. So what we need to offer is the international opportunities and growth opportunities in general which we can offer as a company. As we grow in a country we increasingly attract top talent. In a few instances we have acquired larger businesses and then it is of course much easier to attract top talent from early on.

Another solution to offset the challenge of attracting top talent in the beginning of a market entry is to use our own managers from another country or countries to spend a certain amount of time in the new country. This would secure that integration of new clinics, recruitment of staff, introduction of medical and financial procedures are successfully implemented.

Every year we enter one new market (at least) and I find it absolutely fascinating and a great learning experience to acquire businesses in countries where there is a great need to grow renal capacity and improve the quality of care of the patients. There are enormous differences between good and bad providers and the impact this has on the patients is also huge.

Renal patients are chronic patients. A renal patient is a renal patient for life. There is no cure, no way back. What one can do is to help the patient to choose the very best treatment therapy (in-centre dialysis or home dialysis) and possibly delay the entry in dialysis whenever we can work preventively with patients who have damaged kidneys but where the kidney is still functioning to a certain degree.

This is what we do at Diaverum — and will continue to do evermore globally.

Looking in the mirror

Posted by: on Feb 25, 2014 | No Comments

I was asked the other day what I enjoy most with doing what I do for a living.

This is an interesting question and not easy to answer. I have come to the conclusion that I do like to be a leader — I enjoy leading people. Leading people is an enormous responsibility but also a true honour. There are of course less enjoyable parts of leadership: for example, having difficult discussions with employees or even firing employees, but this is something that does come with leadership. There will always be people who are not right for the company and then they should not be with the company.

I read a book some years ago called From Good to Great. This book has fascinated me ever since. It was written by Jim Collins in the 1990s and is the best book on leadership I have ever read. The book is evidence-based which makes it even more compelling to read. The book describes ‘Level 5 Leadership’ and how level 5 leaders ‘look in the mirror’ when things go wrong. This is explored through a few key themes:

  1. People first, then strategy. Getting the right people on the bus and the wrong people off the bus. To achieve this, the recruitment processes in a company typically need to be amended (for example, attitude is more important than technical competence). Equally important is to realise when a person should be removed from the team. Having the wrong people on the bus is very dangerous for any organisation. Once you have the right people on the bus, the problem of how to motivate and manage people largely goes away. The right people do not need to be tightly managed or fired up; they will be self-motivated by the inner drive to produce the best results and to be part of creating something great.  According to Collins, “if you have the wrong people, it does not matter whether you find the right direction; you still will not have a great company. Great vision without great people is irrelevant.”
  2. Important to always confront the brutal facts. Remember Kodak: it did not realise it was in the imaging business and not in the photography business. They went bankrupt as a consequence. This involves understanding what the members of the organisation actually think about the company, an internal satisfaction survey. Establish the facts and not blame anybody for one’s own mistakes as a leader of a team.
  3. According to Collins, a great company does one big thing consistently. Trying to do many things and not understanding what the real priority is will not make a great company. It is all about securing that key priorities are agreed and that they are communicated at every opportunity. A great company does what this company is best in the world at. It is important to define what ‘best in the world’ means. For Diaverum, this could be to be the most patient-centred renal care company in the world. Good-to-great companies do what they can do best (as opposed to what they want to do best), what they are deeply passionate about, and they focus on what drives their economic engine.
  4. A great company also focuses on the key economic drivers and works hard to keep things very simple. Key economic drivers in the case of Diaverum could be share of clinics with more than 100 patients or a patient satisfaction score on or above a certain level. I am a strong believer in the concept of securing highest possible medical outcomes, patient satisfaction scores and staff satisfaction scores. Any Diaverum centre with great performance in these three areas will also be a profitable centre.

The ‘Level 5 Leadership’ is a very central theme in the book. What does it mean for a leader to ‘look in the mirror’? According to the author this means:

  • taking responsibility;
  • not blaming others;
  • setting high standards;
  • leading by example.

I do fully agree with this. A good leader assumes full responsibility; he does not blame others for mistakes. Setting high standards and leading by example is also truly key. In addition to this I believe that a good leader is someone who says “we” and not “I”.

How many of us have worked for leaders who say “I” when it should be “we”? I have had such leaders in the past and been very frustrated by this.

Level 5 leaders are not charismatic, media types. Chances are you’ve never heard of them. They are humble, self-effacing and more concerned about the prosperity of the company than their individual success.

I can recommend you to read the book if you have not already done so.

Enjoy!

Foto på Dag Andersson