Pelayo de Merlo's Profile

Joe,

Thanks for the post, I think it is a great topic; much has been promised in the latest M&A spree but the reality is that over 50% of these M&As fail in the end.

Crucial factors to consider:

1. I think that the main factor to consider when faced with the M&A dilemma is a strategic one: either if you want to do things better than your competitor or you want to do different things from him – horizontal,vertical M&A – the ultimate issue to ponder when assessing the M&A´s success is the enhanced value that will be created through such M&A.

2. The main driver of this potential enhanced value post M&A is the synergies that would be created all throughout the hospital/company; operational and financial synergies.

3. Another important aspect to consider is the cultural fit between the two merging hospitals.

** Decisions to M&A based just on a volume or market share increase – and that do not take into account value, synergies and cultural fit – are just doomed to fail in my opinion.

Camilla, great questions regarding healthcare´s digital transformation.

It is my belief that doctors might be reluctant to embrace the power of digital transformation due to the lack of a comprehensive and robust strategic and cultural roadmap supporting these technologies.

Most hospitals are delivering a fragmented and siloed technology that fails to add value to patients; costs keep rising, value is not achieved. Moreover, healthcare´s heavy regulation has traditionally acted as an impediment to disrutive innovation within the sector.

Integrating these technologies in the hospital´s overall strategy, explaining how digital transformation will create value by reducing costs and improving clinical outcomes, devising a gradual implementation scheme are just some factors that might help.

Our hospital provides for complex surgical cases that range from lung transplant surgeries to cardiac cases, covering less demanding general surgery patients as well.

We opted to go for a general 30 bed ICU, realizing that all these surgical cases shared an estimated 75-90% of the same resources; antibiotics, inotropic drugs, some sort of mechanical assistance …

However, we devised some critical functional units within the ICU to treat certain conditions that required special resources/knowledge.

As such, I was in charge of the postoperative management of all lung transplant cases; supervising my team, managing specific resources for this subset of patients, interacting with the thoracic surgeons and pulmonologists.

My other peers would be in charge of different surgical units.

However, we all shared the same space, shared most of the physical resources, performed our daily meetings – where we would share our patient´s status together – and we all benefited from this knowledge-sharing meetings.

We created a culture of synergistic cooperation while fostering subespecialization through the creation of functional work teams and avoided the duplication of activities and resources that would come along with the creation of separate ICUs in a general hospital such as ours.

Great conversation so far.

I would agree that concentrating patients in fewer hospitals would allow for better care, related to greater expertise gathered through greater patient volumen.

The issue in my opinion is how to best achieve this concentration:

1. Allowing patient´s freedom of choice.

2. Disclosing medical results among, not only the medical community, but also among the patient population –> full medical transparency so that patients will choose the fewer hospitals with best results.

3. Creating bundled payments for prostate cáncer intervention, including in these bundled payments complication rates and clinical outcomes of the best practicing hospitals (severe compolication rates 0,14%, incontinent rate 35%, for example) –> this would place a greater financial burden on those hospitals that do not adhere to these rates, making them pay for the complications.

** Financial burden and patient´s freedom of choice would place a greater strain on those underperforming hospitals, causing a more natural patient flow selection towards best achieving medical centers.

We have recently implemented registration patient kiosks at our hospital (Hospital CIMA, Barcelona) as a way to improve patient satisfaction (convenience, reduction in waiting lines, for example) and increase operational efficiency (OE).

Some of the highlights of this experience at our hospital have been:

1. The need of these kiosks to be integrated in the overall hospital IT-digital strategy.

2. Functionality:

Multi-lingual.
Ease of use.
Privacy guarantee.
Begin the implementation with basic functions.
Greeter to explain the basic kiosk´s functionality.

3. Location:

We have installed two kiosks at those hospital departments with most returning patients (pediatrics, oncology).

* Constant monitorization of how patients are using our kiosks is allowing us to make continuous adjustments to both software & hardware in order to achieve the targeted goals of patient satisfaction, OE and operational integration.