Alejandro Alfonso
Hospitals and President of the National Association of Private Hospitals
View from the Top

ABC Hospitals Commits to Healthcare Improvement

Wed, 09/07/2016 - 13:15

Q: As President of the National Association for Private Hospitals, how are you planning to strengthen the sector?

A: I spend most of my time meeting with local and federal authorities including the General Health Council (CSG), which is one of the most relevant organizations involved in the creation of Mexican healthcare policies. We discuss issues related to medical tourism, its quality, and areas of improvement. Attracting patients from abroad is mostly contingent on the quality of service. Unfortunately, many non-certified physicians provide unsafe services throughout the country. Therefore, the CSG aims to create a network of certified specialists, ensuring patient safety along the care continuum. Due to the lack of standard procedures and proper physicians’ credentials in Mexico foreign patients undergoing hip replacement surgeries in Mexico realize that no service provider in their country is willing to offer rehabilitation therapy and follow up examinations. There are private hospitals bordering the US that perform surgeries on obese patients, who should otherwise be carefully examined and selected for bariatric intervention. Only 30 percent of patients filing applications at our obesity clinic are suitable candidates for surgery, the remaining 70 percent are directed to exercising, dieting, and enrolling in group therapy. Even if in the short term performing blanket surgeries without factoring individual circumstances may be lucrative, it will eventually damage Mexico’s image. We must work hard on standardizing methods and world-class procedures in the care chain. We do not expect much revenue in the short term but we will show the world Mexico’s ability to deliver high quality services in the long term.

Q: To what extent will the CSG certification help hospitals improve their standards and image among foreign patients?

A: Although accreditation is a requirement guaranteeing patient safety the CSG has many auditing requirements stressing the organization. We believe the accreditation process should be reallocated from the CSG to a capable and highly resourceful third party organization. Mexico could then replicate models like the Joint Commission International (JCI) and the Canadian Council. These non-governmental organizations are funded by private hospitals, insurance companies, the government, and pharmaceutical corporations, among others.

On the contrary, the CSG is subject to administrative changes at the end of each term, constantly losing its experienced personnel and know-how. We should also take into account that CSG audits are free of charge whereas similar JCI processes cost up to US$200,000. JCI is highly experienced in researching and analyzing quality standards, which is a missing practice at CSG. Private sector investment is crucial in creating a solution as it can bring fundamental benefits to the entire sector. So far, 3-4 percent of Mexican private hospitals have received certifications, and most of Mexico’s private infrastructure works without guaranteeing a quality standard. Medicine has progressed impressively in the past few years, and today we can identify previously undetectable diseases. In addition, providing treatment to chronic diseases patients is secured, ensuring them better quality of life. Creating a solid medical network with proper processes and infrastructure is fundamental as a patient’s medical care could involve up to five physicians per diagnosis.

Q: How is the Association addressing the lack of data sharing among hospitals on clinical outcomes?

A: This is a global trend that is not exclusive to Mexico. A few weeks ago, the board of a public hospital held a meeting in which a figure for infection rate was presented but there was no reference or baseline parameter that could help interpret it. Failing to acknowledge medical mistakes is one of the industry’s biggest problems involving indicators. By shifting the mentality, directors could use data as a pathway to continuous improvement. Secondly, leaders must inform their staff on how their work affects indicators and realize that accountability and trust are two main issues in Mexico.

Q: What can be learned from ABC Hospitals experience in earning the JCI accreditation?

A: We are an accredited JCI hospital but if inspections reveal there have been healthcare oversights we could lose it. However, organizations do not understand that accreditation serves as a means to an end, not an end in itself. Nine years ago when we first became JCI certified the process did not end there. The JCI accreditation is a tool to improve, which has to be clearly understood by all members in an organization. Our mission is to serve patients and improve their quality of life not retain an accreditation.

Q: How would you justify investment in procurement when there is a growing concern about underutilized beds?

A: Both the public and private sectors struggle with this problem. Many politicians think that infrastructure development resolves many of the healthcare industry’s challenges. But this approach worsens the problem. Scarce resources are used to build new hospitals and acquire equipment but there is still a lack in human talent. When a new facility opens and starts operating the directors must find qualified nurses, physicians and technicians, as well as implementing processes, best practices and international rules. Infrastructure is often used as a way to prove growth and investment in the sector but human talent development must significantly advance. The Ministry of Health should question whether Mexico has the right people and processes in place, and whether purchasing cutting-edge technology is actually going to solve the current problems in the system. Once the issue is solved then infrastructure expansion in healthcare services should be considered. We need to double the number of nurses over the next 10 years to satisfy the demand for services while providing staff with the right training courses and qualifications. Considering medical and science advances, including the discovery and development of new treatments, staff needs to be trained up to par.

Q: To what extent is your teaching program supporting the development of the sector?

A: We have a strong residency program as part of our partnership with ITESM’s School of Medicine. We will not see significant change unless we educate the new generation of physicians. We approach them in their late teens, starting their college education. Considering that many courses date back to 1970 we need to change physicians’ mindsets so they are able to face upcoming global and local challenges.

Q: What is the scope of your social responsibility programs to improve the health of Mexico’s population?

A: We have an extensive outreach program. We are creating a new plan solely focused on children. There is plenty of scientific data showing that the development of children will be negatively affected if they do not receive enough medical attention during the first three years of life. We also have a Kardias program for congenital heart diseases through which 100 surgeries were performed last year. This is an affiliate of Texas Children’s Hospital in Houston, and is committed to providing the same quality of service in infant medical care. We have other initiatives that address cleft palate, Parkinson’s disease, and kidney transplant. Last year, 90 kidney transplants were completed and 30 of them were performed in Mexico’s most vulnerable population. Our initiative for Parkinson’s disease consists of treating the symptoms by positioning electrodes in the patient’s brain. We have also carried out hip replacements and bariatric surgeries for vulnerable people. In fact, 7 percent of our revenue is invested in vulnerable groups and education, accounting for MX$350 million (US$18.8 million) each year.

Q: What are your strategic plans for 2016?

A: We are in the process of building a new intensive care facility at our Observatorio Campus, which will include a larger transplant unit and a palliative care unit. We will further expand our hospital buildings in Santa Fe, installing specific equipment for the Kardias program, as by 2020 we expect to perform 400 surgeries for congenital heart disease annually. We have plans to build eight additional operating rooms in Santa Fe totaling 14. We are projecting the opening of a third hospital in the northern region of Mexico City. We have two clinics in Mexico City including breast imaging centers with laboratory, rehabilitation, and obesity treatment services. In our main building we have a simulation center that aims to stop the use of animals for educational purposes turning to robots instead. Finally, our residency program for oncology and neurology is growing. As of today, we have 180 residents in both facilities, which we expect will increase in the short-term.