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 true art of delegation

Posted by on Sep 21, 2011 | One Comment

Delegation has been a buzz word for as long as management books and management training exist. There are millions of theories and “how-to´s” when it comes to delegation in business. But I am not talking about delegation of work, that one does not want to do oneself. I am not talking about delegating projects, but keeping the ownership and the responsibility. I am talking about getting a team involved, creating commitment, true ownership and accountability. Because this is what it needed in a successful company or organisation, especially in times of crisis. We need leaders that burn for the company, show true passion and drive excellent results.

When we at Diaverum started building our new brand, vision and mission (we were previously named Gambro Health Care, but changed the name when ownership changed in 2007), there were many “to do´s” and many decisions to be made. Time was an issue – as it always is – and it would have been easy for me to work with an experienced brand agency on a nice and fresh vision and mission.  To be cited on our website and in our documents. I am saying this, because this is how it is normally done: by an outside agency. But a vision and mission not involving people from within the organisation will never reach the heart and the soul of the employees. This is why I decided to get all country managers and executive team members around a table and jointly develop the brand platform including vision, mission and values. It took us a few days days, including late evening sessions and liters of coffee consumed to arrive at the brand platform which felt right for the company. And the outcome was very positive: There is today a highly motivated executive and country management team in Diaverum eager to deliver on the brand promise and to ensure that all 17 countries which we operate in work in a similar way. Everybody knows the important role he or she plays in making this a reality and it does pay off. Since then, this group of people is “co-owners” of our strategy. We meet twice a year to work on strategy and follow up on our plans and I know that I can fully trust this group of people, having full responsibilities, making their own mistakes and enjoining the results. Certainly it takes a bit of holding back as a leader , particularly when you want alignment, buy in from all key decision makers and therefore trusting one’s team and  not being afraid to delegate is absolutely key for successful leadership.


Contemplating pros and cons of living as an expatriate

Contemplating pros and cons of living as an expatriate

Posted by on Sep 1, 2011 | No Comments

My family and I are typical expats. Our roots are in Gothenburg on the Swedish west coast, but for the last few years we have been residing in Munich, Germany. Before that we lived in London for a couple of years. That easily raises the question: Where is home? My wife and I have three children, a daughter of 12 and two sons aged 16 and 17 and our children have spent a great deal of their childhood in various cultures. I believe there are two approaches to being an expatriate family – either feeling guilty for not providing a solid base, or embracing all the special opportunities this kind of lifestyle offers.

Europe versus the US
There are lots of opinions about living a mobile life, but few facts. Geographical mobility in Europe is quite low. This is especially true for some parts of southern Europe where families can live in the same house for generations.

The opposite can be seen on the other side of the Atlantic. The States has a history of settlers, and being on the move seems to be a part of the national American character.

Not as easy as it might seem
Statistics shows that in 2010 there were about 200 million people living abroad. And according to a study done by justlanded.com among German expatriates in 2008, many seem to underestimate the challenges of moving abroad. As a general rule, the survey showed that 68% of expatriates found the move abroad “more difficult than expected”. The biggest problems mentioned of German expatriates were:

  • Adapting to the local culture (85%)
  • Finding new friends (72%)
  • Learning the local language (42%)
  • Finding accommodation (38%)

(Source: justlanded.com)

Our first move as a family took place in 2001 when we relocated to the UK. Our children were still quite small (2, 6 and 7) and immediately got integrated into the British school system. Within half a year their English was fluent. When it was time to move back to Sweden, after four years, the children were more than resistant to come along and actually wanted to remain in the UK. Once back, we decided to sign the kids up for the international school in Gothenburg.

Boarding schools
But, when time came to relocate once again, this time to Munich, our sons announced they wanted to go back to the UK and study at a boarding school. This might seem like quite an uncommon alternative and often causes a raised eyebrow or two. For our family, however, this is a solution that has worked well. The rest of the family now lives in Munich, where the boys come to stay during holidays.

Finding a model that works
One thing I’ve learnt is that there is no right solution for everybody. Each family has to find what is best given their special circumstances. Today’s world is full of swift changes. Having an international background definitely teaches children how to adapt to new situations and cultures. A true gift, I believe, in this world of ever-increasing mobility. And it is absolutely true that the younger the children are, the quicker they adapt to a new environment. To move abroad with teenagers is therefore more challenging than moving abroad with very young children.

I also believe that moving on a frequent basis becomes a “life style”. I would personally get bored very quickly if I lived in the same house in the same city for too many years. I like change, frequent change, and I hope that my children will look back on their youth with fond memories of having lived in various cultures and homes.

When I ask my children where home is, they do answer Gothenburg! Therefore the family spends a large part of the summer and Christmas holidays in this city.


Keeping energy levels high – even though you’ve just crossed six time zones

Keeping energy levels high – even though you’ve just crossed six time zones

Posted by on Jul 4, 2011 | One Comment

– Once I had a very important meeting in London with ten hours of presentations ahead of me. I arrived at my hotel the night before, longing to go to bed after a long day. That night turned out to be a true nightmare. Every now and then, the entire room started trembling. Since I was in a dazed and sleepy state, I first thought it was an earth quake – until I realized my room was next to the elevator shaft! That night I basically got no sleep at all, and the next day was dreadful. Since that experience I plan all my trips meticulously and well ahead.

Business travelling is about work. That means there is no time for being tired. You have to be mentally present many hours a day. You have to be efficient. You have to get to know new people – and most of all, you need to enjoy what you are doing. However, achieving a high level of energy is an art, especially if you have just crossed the ocean, and many time zones.

Stick to your routines. Live as if you would back home, no matter where you are. That is my key to success on the road. These are my four must-do-routines.

Stick to a healthy diet
Elaborate business dinners and greasy hotel breakfasts can quickly undermine any attempt to a healthy diet. Expanding the waistline is easily done, but not a very good idea if you want to enjoy a long and healthy life. Breakfast is important to me and definitely should not remind me of my time in military service (which it surprisingly often does even at some highly priced hotels.) A good breakfast simply makes a wonderful start of the day. Healthy food, in reasonable amounts and at regular hours is essential – even in countries like Spain where supper rarely is served until late hours.

Put on those jogging shoes
I generally travel light, but in my suitcase I always have room for a pair of training shoes. Before booking any hotel I make sure there is a good jogging track nearby or at least access to a gym. Going for a forty minute run makes miracles.

Keep a positive frame of mind
I try not to think too much about jet lag. If you think about jet lag and its possible consequences on your mental state you will for sure get jet lagged. If I land in Latin America in the evening I go to bed at night, just like everybody else. I simply adapt wherever I go. Once I arrived in Sydney, Australia, in the morning after an overseas trip. Instead of plunging into bed (and that is really what I felt like doing right then) I put on my jogging shoes and got back refreshed to continue the day.

Choose your hotel wisely
I carefully select the hotels that I stay in. I generally prefer smaller (small to me means less than 100 rooms) and family owned hotels. Before arriving, I ensure the hotel is well aware of my preferences when it comes to choice and location of room. One should not have to use ear plugs when paying a large sum of money to sleep.

Tripadvicer.com is an excellent source of information. I read it in order to find out what previous guests have written about a specific hotel and several times it has actually stopped me from making a reservation.

A last advice is never to accept a room on the top floor. This lesson I did learn after staying on the 40th floor at a hotel in Singapore. In the middle of the night all alarms suddenly went off. This time it actually was a fire, and not the elevator. After having sprinted down 40 stories three a clock in the morning I decided from then on to always request a room “not at the top”.

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.






Up in the air – the art of making business travelling enjoyable

Up in the air – the art of making business travelling enjoyable

Posted by on May 4, 2011 | No Comments

As I am writing this I just landed after a long flight between São Paulo, Brazil, and Munich, Germany. In a few hours I am catching another plane in order to attend next meeting. I spend many days a year crossing the globe, and I am well aware that travelling can be painful. Delayed flights, crowded airports and inefficient security checks can cause stress, a lot of stress.

I have seen many well mannered business people suddenly turning nasty and rude the moment they enter an airport. With bags in hands and elbows out they make sure nobody has a chance to board the aircraft before them.  Once airborne, the business man (I have no prejudices – but I rarely see aggressive business women at the airports) starts up his computer and taps away on the keyboard, making sure all e-mails can be sent off immediately after landing. And the moment the wheels touch ground Blackberries and Iphones are switched on. Frustration grows. Teeth grind. Stress mounts. Does it have to be like this?

Years ago I too used to turn into one of these unbearable business men. However, time has made me wiser. Nowadays I keep my energy up following some common sense rules.

I always arrive early at the airport
Actually, I am proud to say that I have never missed a flight. Getting to the airport with plenty of time on hand is such a stress reliever. There is absolutely no reason to be late. I can get plenty of work done in the airport.

I keep luggage, clothing and loose items to a minimum
Not having to check in a suitcase is a huge time saver, and less is definitely more when it comes to making it through the security control. I keep jackets, belts, bags and other unnecessary items to a minimum.

I make sure to have access to a business lounge
Getting some work done at the airport requires peace and quiet, a commodity that is to be found at the business lounge. There are three ways to achieve access: Through a Diners Credit Card, with a Priority Pass or having collected enough frequent flyer points.

I use the Online Check-in service
Most airlines have this service available 24 hours before flight departure time. With no bags to check in and boarding pass in hand I can head straight to the lounge. Checking in online also gives me the benefit of choosing an aisle seat way in front. This allows me to get off the plane quickly and saves me from climbing over my fellow passengers if I want to visit the restroom.

I am the last passenger to get on the plane
There is nothing like the turmoil that emerges when a large group of travelers enters a plane at the same time. Hand luggage, elbows and coats swing through the reduced space. So even if I am early to the airport I make sure to be the last one to board the plane.  This way I can also spot if there is a free row of seats available. Not having to be jammed in with strangers for hours makes travelling so much easier.

It is amazing how some common sense rules can keep the blood pressure down and spirits high. Business travelling actually can be quite enjoyable.










Using social media: Getting your strategies right

Using social media: Getting your strategies right

Posted by on Mar 30, 2011 | No Comments

I have been a keen follower of Twitter for several years. It gives me up-to-date information, is easy to follow and – it only takes a few words to get the gist. Twitter is the absolute antidote to long essays, a huge benefit for anybody living a busy life!

But, what is the correct way to use social media? Some users prefer to be constantly connected and active. Others have a more conservative approach.

For me social media is a way to stay informed, both professionally and personally. It helps me keep in touch with family and friends back home in Sweden (since work has taken me to Munich). Even so, before taking my first step into the sphere of social media I decided to get my strategies right.

My 5 must-answer-questions before getting into social media:
1) Why do I want to use social media in the first place?
2) What is my goal with using the specific media?
3) Do I want to tweet and post actively? (That does take some time)
4) How public do I want to be?
5) What kind of digital footprint do I want to leave on the web?

As a CEO of a large company I rarely do something without having my goals clear, this goes with the profession. Setting out the path for using social media was similar to making a business decision.

Obviously everybody has different answers to the above questions. There is no right or wrong answer. The important thing is to think before acting, and then go ahead. Social media is a great tool that can make life easier and more fun, provided it is used the right way.

I personally use Linked In, Facebook and Twitter, and my approach for each one is different. However, as a general rule I prefer to have a conservative approach.

Twitter for quick updates
Twitter is definitely the social media of my choice. It lets me choose the exact information I want to access. I follow the stream from various daily newspapers and newsproducers. I also get the latest information about business news, competitors, airports, restaurants, wine producers and much more.

Facebook for keeping in touch
Since my work takes me all over the world, Facebook is a way to keep in touch with friends and family. As a conservative Facebook user I only add friends that I actually have a close relationship to in real life. I rarely take the time to post up-dates myself.

LinkedIn for professional reasons
LinkedIn is purely business. I use it to get to know competent professionals across the globe.

Answering the five questions does not take too much time. And once you get your strategies right there is a whole world out there to connect with and get information from.

Foto på Dag Andersson