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.


Using social media to fill our patients’ information needs

Posted by: on Jan 18, 2013 | No Comments

I have not contributed with a blog for quite some time. At the start of a new year, it is common to make promises and commitments. I will now try to blog more frequently, in particular when there is a certain theme that does interest me and I want to share it with other colleagues and friends across the world.

Social media — that is just a passing fad, right? Hardly! We talk often about social media these days; Facebook has more than 1 billion member accounts, Twitter several hundred million.

The question that we in Diaverum need to answer is: what role does social media play in the area of healthcare and healthcare services in particular? Another question concerns patients and staff in a clinic or hospital: how common is it that they use social media to educate themselves, to share best practices, to connect with other patients or staff?

There are no easy or straightforward answers.

In Diaverum, there are patients today who ‘tweet’. There are employees in our kidney centres and countries using Facebook to reach out. I try to follow this as much as I can but for obvious reasons it is difficult to follow everything that is written about Diaverum; however it is wonderful to witness the stories being told.

When visiting clinics around the world (Diaverum is now present in 18 countries and serves almost 22,000 patients), I have met patients who connect with other patients via social media during their treatment sessions. Just to give you some insight into life in the clinic, our patients are typically spending 18 hours per week in a clinic. In most cases a treatment session lasts for 4 hours but there is work to be done before the session (e.g. lab tests, check-ups) and also after the session which means that the total number of hours spent in one of our centres amounts to approximately 18. This is how it works week in and week out, year in and year out, unless the patient receives a transplant or is on our home care programme.

Many times it is hard to kill the time that they spend. Yes, books can be read and TV can be watched, but an increasing number of patients want to use their time on dialysis to communicate, to reach out. An increasing number of patients and relatives also want to use social media to learn more about the disease and how to live a life as rich as possible with the disease. And we need to act as the enabler for this.

There are some statistics that I have read recently that allude to this theme. A report from PwC, published in the spring of 2012, shows that one-third of healthcare consumers (not only related to dialysis) use social media for seeking or sharing medical information; 41 per cent say tools like Facebook, Twitter, YouTube and online forums influence their choice of a specific hospital, medical facility or doctor.

Even more interesting is the fact that 57 per cent of consumers said a hospital’s social media connections would strongly affect their decision to receive treatment at a certain facility.

Even if these numbers should be read with a degree of caution it is clear that a healthcare service provider needs to include social media as part of its business strategy and not only see it as a marketing tool. We need to be part of this discussion. I want to encourage patients and staff to share stories and best practice.

To answer the questions I set at the start, this is the role we have to play. In Diaverum, with our global reach, I am sure that patients and staff can inspire each other and support each other. What is done well in a certain area in one country can be picked up in another country.

And it will only become more important to get this right. If we look at the global picture, the number of people throughout the world with chronic kidney disease or with end stage renal disease is increasing year on year. By 2020 the number of patients dependent on dialysis to survive will have increased from just over 2 million in 2010 to almost 4 million. The need for these patients and for the staff caring for these patients to reach out and to communicate via social media is definitely going to increase.

And I’m personally looking forward to a year with increased focus on social media within Diaverum.


The sounds of our lives?

Posted by: on Feb 10, 2012 | One Comment

There is  no doubt that smartphones have revolutionised how we live our lives. This is the information age, after all, and the smartphone keeps us plugged in to the information flow wherever we are in the world — we no longer have to wait till we’re back at our desks to read that important email, it’s right there in our hands.

Of course, the flipside can be seen when you peer inside today’s meeting rooms. The number of gadgets has exploded over the last couple of years — no longer is it the case where only laptops are present, but also smartphones, iPads and other such devices — and that also means that the number of distractions and unpleasant electronic sounds and signals which irritate people around the table has also increased.

Looking closer to home, I have recently added a ‘no gadgets’ rule to the executive meetings that I lead.

All of which has led me to think about this question: at what point does our dependence on electronic devices go too far?

Psychologists have a growing concern with smartphone dependence. People are displaying behaviour that shows they would rather interact with their phone than with other human beings. This is naturally a worrying behaviour, but is it too far, and is it really any different to addictive video-gaming?

Perhaps, but it appears too that it is not just an issue for the younger generations. Teens and adults are showing addictive behaviour to their smartphones that in some cases is causing harmful consequences.

Some are minor, such as teens talking in three letter words such as LOL and BRB — although this is more offensive on the ears rather than being anything sinister. Other behaviours are more destructive, however, such as car accidents caused by people texting or looking up information on smartphones. Clearly too far.

There has also been a lot of research into the area of the usage of smartphones, particularly teens’ attachment to their smartphones. The researchers found that when teens were separated from their phones, they were under-stimulated. The indicators were a low heart rate and the inability to entertain themselves.

Another study shows that 47% of teenagers admitted to using their smartphone when in the toilet (only 22% of adults confessed to the same habit). Too far? Probably, and certainly enough to make you think twice before borrowing someone else’s phone to call or text.

But back to the issue of gadgets in executive meetings. A meeting where people are constantly checking messages, emails etc. on their smartphones is not a productive meeting. People need to be present and focus on the ‘here and now’ in the room. Therefore, my personal view — and one that we live by in the meetings that I lead — is that smartphones and other such devices are forbidden. And this works fine when there are enough breaks during the meeting day to allow for people to check messages and or emails.

  • In case you were wondering, these are the rules by which I lead my executive meetings:We start always on time
    No computers / iPads / technical equipment on the table
    No mobile phone on or under the table
    There will be breaks to enable calls and other urgent matters
    One person speaks at a time
    Be present
    Prepare each point well

Quality is key

Posted by: on Nov 21, 2011 | 4 Comments

In my last blog post, I discussed the idea of connecting patient satisfaction to reimbursement rates in the health industry. But patient satisfaction is not only about having a television to watch and receiving a good breakfast or lunch. For the well being of the patient, the quality of the medical treatment is absolutely key. A high dialysis quality enables them to pursue more of a normal life. How can we ensure the highest possible quality of care and medical outcome?

Some countries have implemented national quality measures. In Sweden for example, an annual ranking in the Swedish renal register (www.medscinet.net/snr/), shows the performance of all dialysis centres and ranks them according to medical outcomes using Kt/V (en.wikipedia.org/wiki/Kt/V) as a measure. This makes the dialysis care very transparent, but can even more be done?

The answer is yes. If we look at Argentina: while the general reimbursement level in the country is rather low, dialysis providers can be additionally incentivised for delivering excellent quality. The ‘quality incentive’ is based on the monthly medical results in each clinic, focusing on a number of important measures such as Kt/V, anaemia, alumina etc. An additional twelve per cent of the general reimbursement can be achieved if targets are met. Conversely, the penalties for underperforming are quite tough. I find this a very interesting approach to foster quality in health care and in my view Argentina is clearly leading the way over Europe.

I am convinced that models like rankings or quality incentives will set a precedent in many other countries. This can only be good for patients. And what does it mean for the providers? Get yourself ready to be tested for quality – every day in everything that you do!


Are we listening to the patient?

Are we listening to the patient?

Posted by: on Oct 18, 2011 | 9 Comments

Earlier this autumn, I participated in the ”21st Economic Forum” in Krynica, Poland. This is basically the “Davos” of Eastern Europe. And it is probably the only forum where East meets West on such a large scale. Its mission is “to create a favorable climate for the development of political and economic cooperation between the EU and its neighboring countries”. A wide spectrum of topics from various sectors were addressed this year including energy, economics and certainly health care.

I was invited to participate in the opening session of the forum together with the current Minister of Health of Poland, Mrs. Ewa Kopacz. What I found interesting about her introductory speech was the number of times she mentioned ”putting patients in the centre” and that she also talked about ”connecting patient satisfaction to reimbursement” in outpatient centres. I was positively impressed by her approach as this is really an issue in today´s discussion on health care costs and cuts across Europe. There is much talk about the need to save money, about possible measurements etc. But what I never hear in this discussion is what the patients have to say. Are they even being asked?

Normally politicians listen to their voters. Apparently they do not in this case. But why? Is it that they are afraid to hear the answer? From many discussions with patients at Diaverum and patient satisfaction surveys I have learnt the following: The patient wants the best possible care, he or she wants to improve their quality of live and wants all this to be covered by the health system. They are basically not interested in who is in charge of providing the care, as long as it is truly best quality.

Knowing this, the health care system could work out concepts that cover these needs. Because a “healty” system is about how the job can be done best, in the best interest of the “customer”, not about who gets which share of what. My view is that for example a mixture of public and private health care provision is good for the system since it encourages competition – the urge to constantly improve. There are several good examples from countries who apply a mixed system. Also, why not really connect the patient satisfaction to reimbursement, as suggested by Mrs. Ewa Kopacz? Success based on customer satisfaction is a model that works extremely well in many other industries; why not apply this to the health care system? Many, many other ideas could be derived from listening to the patients – and deployed to their benefit!


The challenges of tomorrow’s health care

The challenges of tomorrow’s health care

Posted by: on Jun 3, 2011 | No Comments

In most industry sectors costs tend to fall with time, due to productivity gains. Look at the electronics industry which is a great example of this. In the health care sector, the opposite holds true. Costs have been rising year on year. Between 1960 and 2005 health care costs have risen at GDP +2.0% (OECD countries) and in the US by GDP +2.5%. In the US 16% of GDP is today spent on Health Care. In Sweden the equivalent number is approximately 9%.

Last week I was invited to participate in a seminar at the Swedish embassy in Berlin on the topic “Health and Care of tomorrow: How to handle limited resources and a growing demand.” Present were H.R.H. Crown Princess Victoria and Price Daniel together with Göran Hägglund, (Sweden’s Minister for Health) and Social Affairs Daniel Bahr (Federal Minister of Health in Germany) and Alan Milburn (Former Secretary of State for Health in Britain 1999-2003) who is also a board member of Diaverum.

It is clear that health care is facing enormous challenges over the coming year. The population is growing older. We are living longer. In the 20th century life expectancy increased with 30 years in the OECD countries. An amazing increase! And it is predicted that 50% of all children born after year 2000 will celebrate their 100th birthday (OECD countries).

This is obviously good news, but a longer life unfortunately does not necessarily mean a healthier one. Currently, 2/3 of all deaths in the USA are attributable to one of five chronic disorders: cancer, chronic obstructive pulmonary disease, diabetes, heart disease and stroke. And with this comes a giant bill – 75% of total health care expenditure in USA is spent on treating chronic diseases!

The picture is similar in other industrialized countries. It is not uncommon for governments to spend 10% of their gross domestic product (GDP) or more on public health care. At the same time, there is an increased demand for improved quality and accessibility.

As the CEO of Diaverum I am fully aware how the needs of dialysis are constantly increasing due to the growing number of people with Chronic Kidney Failure (which eventually results in End Stage Renal Disease).

So, how do we handle the seemingly impossible equation of limited resources and growing demand? The seminar in Berlin did point at some possible solutions.

Freedom of choice drives innovation
Current trends in health care include giving the patient more freedom of choice. Studies show that this has a positive impact on both cost and the quality of care provided. Freedom of choice increases competition and this in turn drives innovation.

Outcome based payment models
Another possible solution is outcome based payment models. The health care industry has a tendency to look more at the quantity than actual results of the care provided. Several countries, including Argentina, are now implementing outcome based reimbursement models.

Results are no longer measured by the number of patient visits or medication prescribed. Instead the quality of care, seen from the perspective of patients, is put into focus. This trend will definitely increase in the coming years.

Preventive measures
The WHO believes that 80% of chronic disorders could be eliminated by implementing appropriate preventive measures. However, a very small portion of the health care budgets is dedicated to prevention. In the USA less than 4 cents of every dollar spent on health care goes to preventive and public-health measures, and the numbers are not much higher in other countries.

Leadership in Health Care
Studies in the UK have shown that hospitals with an autonomous status and clear organisation/leadership are performing better than hospitals and health care institutions with no clear organisation and leadership. The more autonomous the units become, the better they perform both medically and operationally.

It is clear that the challenges are great and I can only urge all health care providers to think how they can contribute to a more efficient and successful health care structure in the future. Focusing on preventive care is such a measure to be taken.






Foto på Dag Andersson