00:00:00:

00:00:14: Hello everyone and bienvenidos to a very special episode of the Strategy & Insider podcast.

00:00:20: Recording from sunny Spain.

00:00:22: I couldn't be more excited about this conversation And that is because today, we're at the center of where healthcare's delivered directly to patients.

00:00:30: Namely a hospital and more precisely The University Hospital Ray Juan Carlos in the south of Madrid.

00:00:37: It also one of clinics already showing what future health care can actually look like by using AI Robotics but also digital infrastructure to transform how hospitals operate every single day.

00:00:49: To discuss this works-in practice I'm really thrilled to be joined with someone who sits at the intersection of medicine, technology and hospital leadership.

00:00:59: So please welcome Dr.

00:01:00: Hoche Schoort Apianis!

00:01:02: Hoche is part of the digital leadership at Kirunsaluth which one of Europe's leading hospital networks with more than a hundred fifty medical centers across Spain an additional facilities throughout Latin America Which are parts of the broader Fresenius and Helios group.

00:01:19: He is a trained physician who previously served as the deputy medical director at The Prestigious University Hospital, Fundanción, Jimenez Díaz right here in Madrid.

00:01:30: he's also led three university hospitals for Kirchhoff-Saluth as regional manager in the greater Madrid area and to me this really kind of rare combination of clinical expertise and digital leadership that gives him perspective on how technology is reshaping patient care from the inside out.

00:01:50: And by the way, I also learned that he's a former rugby player and makes it all more exciting!

00:01:57: So Roche thank you so much for having me here in Madrid.

00:02:00: It really great to be with you today.

00:02:03: Thankyou very much for coming and taking your time and have a chat this morning.

00:02:09: Yeah, so you present us here.

00:02:11: a very nice weather of course but also a very well-organized hospital I have to admittedly say.

00:02:18: But before jumping anywhere nearly everyone these days and me including seems to be wearing some kind of digital health tracking device whether it's smartwatch or even a smart ring that i'm wearing today You now being also a physician, turning digital health leadership into your day-to-day living and job.

00:02:41: I'm really intrigued to ask do you personally use one of these gadgets devices?

00:02:46: To monitor your own health?

00:02:48: And if so has it changed the way you think about patient data yourself Being in the practice there?

00:02:54: well too me i Think is not So much About getting that data which i think It's more than necessary but I think everybody is going to gather their all information.

00:03:07: if they're not doing so right now.

00:03:08: They will in the following years, i think that key point is... Not uh.. All these gadgets that they exist.

00:03:17: But how do you put all of this information altogether?

00:03:21: Where can handle all those informations together?

00:03:24: and If there's something You Can Do With All This Data?

00:03:26: Together Inside this hospital and inside our company in Kiran Saluth, we pursued... We managed to create our own patient portal.

00:03:36: Ten years ago or twelve years ago when actually it was at the same time as opening of another public hospital that we take care off in Villalba, we created a patient portal.

00:03:47: The patient portal is quite amazing right now because its over nine point four million people in Spain are using it.

00:03:55: Actually if you take a look at that, I don't know the percentage of Spain but that would be what?

00:04:01: Nearly seventeen percent of the population will use the patient portal.

00:04:05: Why am saying this?

00:04:06: is because yeah It's great to have all these gadgets But then we've got an app that can integrate all these gadgets and you have an app, which integrates data from yourself inside your clinical report.

00:04:21: And this is exactly what the patient portal does because in all of its information it allows you to do prevention campaigns but also if you're having any chronic disease or acute disease I could tell you everything about it.

00:04:36: It's growing fast!

00:04:38: Data always good.

00:04:41: Again, you need to know what to do with this data.

00:04:44: A few weeks ago it was very interesting here in Spain and one of the national newspapers there was a news between prestigious doctors that said about are we getting too mad?

00:04:57: About gathering all the data were having because I've walked ten thousand steps my heartbeat is not above ninety, I'm sleeping in half hours blah blah.

00:05:10: So

00:05:10: doing everything right at the end?

00:05:12: Yeah

00:05:13: or to write because you don't have to be obsessed Because there's trouble is if you have information and it does your good that's good.

00:05:23: but If the information Does not do your good mentally It will take a look at this.

00:05:30: But answering your question I do have a smartwatch.

00:05:34: Yeah, yeah i do measure my steps um heartbeat all the times i sleep etc.

00:05:40: etc.

00:05:41: but The last thing i was saying exactly you've got to take it slowly i think.

00:05:46: And what is more important?

00:05:47: Is to have something someone that can analyze All this for you.

00:05:51: and inside kiron salu we had the patient portal.

00:05:54: That's actually the best tool We've gotten side of company.

00:05:58: Thanks

00:05:58: for sharing that.

00:05:59: And can I just ask on the patient portal you're having, is this kind of an open source where you can upload an Aura ring or Voop information and whatever data there's?

00:06:16: You could download it right now... put your information you need and you could start using the app.

00:06:23: It's great because it is not just an information tool where you can know your appointments, all of your clinical reports... You see your last CT scan or electrocardiograms but imagine that you are coming from another country.

00:06:37: Or if you come to a hospital brand or whatever.

00:06:41: then you can start taking photos with your latest clinical records and automatically upload them and it analyzes the information you have inside your app.

00:06:52: This app has been doing a great evolution in the last years, not only that we've had information but what I was saying is its communication tool between doctor or nurse on patient.

00:07:06: this communication tool does no need to be at same time because for example imagine you're a diabetic patient you're going to be a diabetic patient all your life, or it's a chronic disease.

00:07:19: So do you really need to come the hospital three times per year if they are doing okay?

00:07:26: Or could you communicate with your doctor and communicate again with your insulin bomb or whatever kind of tool that you have to introduce yourself?

00:07:37: I mean we've created different ways about treating and taking care of the patients.

00:07:43: Much more direct, much more personalized

00:07:46: And I can very much relate to that.

00:07:48: So it's also kind of being there for patients when they really need help, but also keeping patients outside the wards if they don't need to be around and making way for other patients more in need before seeing a doctor at the end.

00:08:01: so did you get any feedback from users on patient portal?

00:08:07: What are they saying about this?

00:08:10: Since the beginning something inside our company we take into account count what the patient says, some things about.

00:08:19: We do a net promoter score NPS of every single thing we're doing hospital in the emergency room, and the appointment room.

00:08:28: And there's surgery room and hospitalization on every single tool we do net promoter score about.

00:08:35: of course The patient portal then it promoters core off.

00:08:37: the patient portal is above seventy.

00:08:39: It's really really high.

00:08:42: and its not only about that promoter.

00:08:43: school around what the patients thinks about their.

00:08:46: it's up out the percentage of use of this app.

00:08:50: because it's not only that nine point five million early of people are to have the app, but The question is Are they really using?

00:08:58: And It's above seventy-five percent Of the patients That have the up.

00:09:03: But I've been using in the last three months.

00:09:06: so there's an app that's being really used

00:09:09: Seems like really in demand.

00:09:11: Can I just stick a little into your career path, which i find really remarkable?

00:09:16: You're trained physician who led several prestigious hospitals and is now heading leading the digital transformation with colleagues for one of Europe's largest hospital networks.

00:09:28: so what drew you from practicing clinical medicine into digital leadership.

00:09:34: Was there kind of a pivotal moment in life where you realized, well tech could really fundamentally change how care is delivered or anything like?

00:09:43: Well

00:09:43: it's something that probably everybody who's listening to the podcast will know and for next ten-twenty years health has going to change much more than whole history.

00:09:55: this is something we now I'd like say crisis, health system is a crisis but this isn't something new.

00:10:04: Probably in the nineties they were also saying we're not healthcare crisis... But what I do think it's moment of cultural transformation.

00:10:16: Cultural transformation!

00:10:17: I think digitalization its catalyst for that cultural transformation.

00:10:23: i think digitalisation should be or at least in our company as the catalyst or the tool to do a cultural transformation.

00:10:33: The real thing is that patients are growing, patient illnesses are growing more chronic diseases coming up.

00:10:40: Patients are older and that's why chronic disease are going higher and higher.

00:10:46: .The tools we have ,the sources we have are limited this something for real at least in Spain or Europe.

00:10:55: it much more so if keep doing the same things as we did, twenty years ago.

00:11:02: We're going to crack ourselves.

00:11:05: so that's why a cultural change is being done already because our patient has already changed.

00:11:12: I was in another meeting last week with different managers of different companies and nothing related to healthcare.

00:11:21: but uh...we were talking when it was the last time someone looked at his app for bank account Two hours ago that same morning the day before.

00:11:31: but when I asked When was the last time you actually went to your bank?

00:11:36: What does that happen?

00:11:37: no

00:11:38: five years ago.

00:11:38: Yeah,

00:11:39: exactly.

00:11:39: or People are buying stuff with their mobile phones.

00:11:44: There's less and less people Actually going to the shops.

00:11:48: know actually there's lots of brands That they're promoting this.

00:11:51: we go through Thara, you know?

00:11:53: Thara is Spanish brand in the techs.

00:11:56: And they're closing down shops because there are going much higher in digitalization and then up.

00:12:03: but when I did that question When was it last time You looked at an app of your health to see how their doing?

00:12:11: There were silence on the room and asked a question Is your bank more important than your own health?

00:12:20: So i think people are willing to transform.

00:12:24: People do want to transform, people have transformed in every single sense of their lives.

00:12:29: so I think health has also had a big important bit on this.

00:12:34: Another example is just an example.

00:12:38: A mythology patient's doctor must see fifteen patients in the morning.

00:12:47: most of them are chronic diseases.

00:12:50: most of them is people that the amatologist already knows and maybe that consultation could be done any other way than in a traditional way.

00:12:59: Why?

00:12:59: Because the amathology really needs time for that first patient, who has always going to be diagnosed with alimphoma... And this patient really needs that time!

00:13:13: So that doctor can have dedication.

00:13:16: The other type of patients can be treated something else.

00:13:21: So I think that in my case, managing this is really passionate because the whole world is changing around us and we can do things differently or better for our patient so they are able to sustain their system here in Spain.

00:13:45: Public system, I love the public system in Spain.

00:13:48: It's one of the best things this country has and it doesn't matter which illness you have... ...you will be treated with that illness.

00:13:57: I've been working at a fellowship there.

00:14:01: The system is completely different but if it isn't the best then they are among the best in the world.

00:14:09: so that the system can be sustainable for twenty years.

00:14:13: Changes have to be done.

00:14:16: And I think that's in the road where Kilosa Luz is doing pretty good.

00:14:21: And a prerequisite for that future of health to really happen obviously is digitalization and as you rightly described, digitisation kind of its omnipresent in life.

00:14:31: In everyday lives but also healthcare given the use started.

00:14:36: personally But also Kieron Saluth started this journey towards digitisation way earlier than many others.

00:14:43: What's one thing that would advise hospital leaders globally when Can they embark on their journey towards a more pronounced digitalization level?

00:14:55: There's been three people that have changed completely the way of doing things differently in healthcare.

00:15:02: Juan Antonio Álvaro de la Parra, who is now the CEO of Quiron Salud.

00:15:06: Marta Del Olmo, who's a regional manager at Public Hospitals in Quiron-Salud.

00:15:11: and Angel Blanco, who was the CIO for QuironSalud.

00:15:15: They were the ones that started fifteen years ago to change things.

00:15:20: And one other very good thing they did... ...and we've kept up these years.

00:15:25: We have been working as one team from beginning Engineers, mostly IT engineers.

00:15:35: Doctors and management team to work as a team from the beginning To have real solutions to real problems.

00:15:44: This is we've got whatever.

00:15:47: The problem is how can We solve it?

00:15:49: And if From you from the Beginning Work As A Team The tool You will manage to create Will be used from that medical Team from the Beginner.

00:16:00: If you create a tool without counting with the people that most know about the clinical problem, you will have much more problems to implement it.

00:16:11: For example if you want to create a clinical pathway for trauma or orthopedic surgery and you don't take into account the orthopedics surgeons from beginning It will be much more difficult than for them to use it.

00:16:26: So I think the key point, most important is being united as a team and doing that at least for us has been one of the keys of success.

00:16:48: I mean, we're now here in Spain.

00:16:50: The Spanish healthcare system is really frequently recognized as one of the most efficient ones in Europe and innovations like electronic prescriptions online appointment management also widespread usage of telemedicine are kind of an everyday live reality while countries like Germany where i'm from were still working on a rollout digital patient records.

00:17:14: What do you think is Spain's secret source?

00:17:17: that you are having in order to make digital health innovation really working the last couple of years?

00:17:24: I think we started a few years ago, more than ten years ago... ...to do all these digital innovations.

00:17:31: But there was something that changed it and that was Covid.

00:17:36: Covid marked differently.

00:17:39: The tools were already the tools but at this moment where a great boom was from Covid.

00:17:47: In Covid, I think lots of patients understood that they could have the same quality medicine as before using their phones or different digital tools.

00:18:00: in the end what patient needs is an answer.

00:18:03: A patient may be frightened and maybe scared but what a patient needs it's an answer.

00:18:09: The way you give this answer probably the best solution for a patient nowadays is as quickly as possible.

00:18:17: Of course, this doesn't mean you do not need to see a patient personally.

00:18:22: I gave an example before in a mythology and lymphoma or more chronicle disease but again being able to do lots of appointments with your mobile phone makes us be much more personalized medicine For these patients.

00:18:39: that really needs time.

00:18:42: So I think people in Spain have understood this and some people in spain want it.

00:18:47: But again, i don't think that's much more about Spain but worldwide everybody is using their mobile phones for so many things.

00:18:56: why not health?

00:18:58: Yeah, not very true.

00:18:59: And once you laid the foundation in kind of digitizing your end-to-end patient journey and hospital I would love to talk a little about artificial intelligence because i know you're strong advocate for AI's role in clinical practice.

00:19:17: you are already deploying AI at scale.

00:19:19: from what I've seen and this is also visible here in the hospital, Ray Juan Carlos where i had actually the honor to get an exclusive tour through the facilities earlier.

00:19:28: but it would love to dig a little deeper if I may.

00:19:32: Beyond diagnostics how is AI changing day-to-day management of your hospital?

00:19:38: Both in a sense of patient management, clinical day-to-day management as well as kind of the more management of the hospital side.

00:19:47: Can you give some concrete examples how your deploying this?

00:19:49: We

00:19:50: created tool two years ago called Scribe.

00:19:54: Cassiopeia Scribe.

00:19:55: In February of twenty twenty four paper and The New England Journal Of Medicine was published mainly this article.

00:20:03: what it said is that AI would be really good in medical routine if there could be any tool that could transcribe a conversation between patient and doctor.

00:20:16: Because this will able to save lots of times, what doctors hate about doing and administration stuff.

00:20:27: So we got the article started working with it.

00:20:31: We created a tool that can transcribe a normal conversation between doctor and patient only with his mobile phone or tablet.

00:20:43: Some

00:20:43: sort of voice recording?

00:20:44: Exactly,

00:20:45: but what it does is inside our system Casio Pea.

00:20:49: we developed around system fourteen years ago.

00:20:53: actually the first hospital started was this one Andrey Juan Carlos, because at Sours we were able to do updates and create new tools inside it.

00:21:04: So the engineers head by Daniel Blanco who was first engineer that started with idea of doing this.

00:21:12: We managed a tool which could transcribe all information between our conversation and put in a clinical report automatically.

00:21:22: Not only does that but It can listen to the conversation.

00:21:26: If I'm a doctor and prescribe you medication, it also collects this and sends it automatically.

00:21:33: if i ask for some tests blood test MRI CT scan gets that and does it automatically.

00:21:41: of course the prescription medical prescriptions have to be validated later on.

00:21:49: But what this made was it changed the way about treating patients, because you don't need to have a doctor typing in all of time while he's talking with his patient.

00:22:00: He can just be having normal conversation.

00:22:03: actually we've change some appointment rooms And they're not normally at desk because that's like a huge barrier, but the round tables where the doctor and patient can just have an normal conversation.

00:22:16: The patients could see their test or in screen like this one when we are having here inside your tablet or whatever.

00:22:24: This was a huge boom.

00:22:26: Actually two were ready on June twenty-twenty four.

00:22:30: We did some tests during that summer And on September, we started to launch it in all the group.

00:22:38: In the fifty-seven hospitals and every single specialty.

00:22:42: I don't know by heart number some figures now but more than four point five million appointments have been done with this system.

00:22:52: And emergency room, one point five emergencies has been treated that way.

00:22:57: This is super interesting.

00:22:58: you had it because I heard about obviously and read about and seen at Amazon Transcribe Medical that Amazon invented in the US.

00:23:07: but to have a European version made from doctors for hospitals and patient conversations was super-interesting.

00:23:15: Now, if this is used by doctors right?

00:23:17: They are obviously having hopefully a better conversation, which happens to quality of the conversation with the patient.

00:23:25: It may also save them quite a lot of time in terms of efficiency gains.

00:23:30: would you expect that your doctors then have more time for one patient who has a better conversations?

00:23:36: or is it seeing more patients and given amount of time?

00:23:40: No no no doctor sees the same number of patients so what they have is more time per each patient.

00:23:46: And again coming back to on previous questions When we did this, We did different groups for every specialty because the clinical report of a traumatologist is not the same as a cardiologist and transcription will also be different.

00:24:02: It hasn't only risen up quality between doctor's and his patient but it has risen very much the quality of the clinical reports!

00:24:14: This isn't silly.

00:24:17: if you have better clinical records patient has more information, other doctors that need a clinical report and might not know the patient have more information.

00:24:26: And for others tools we are developing in reading their language inside the clinical reports will also be better.

00:24:36: I mean with an AI implementation healthcare probably little different to other parts of life.

00:24:42: when doing shopping it is obviously crucial to diligently balance innovation?

00:24:48: with patient safety.

00:24:50: Clinicians need to trust the tool they are using and patients needs to trust that their care is not being delegated just an algorithm but somebody knowledgeable looking at it in end, validating and contextualizing what do you see as key element or other key elements for successfully and safely integrating AI into clinical workflows so everybody can trust?

00:25:14: We've been very careful to what the tool really does and doesn't do.

00:25:20: The tool only transcribes the conversation between a patient or doctor, this is important for patients who don't record it anywhere.

00:25:30: It's actually destroyed after transcription has been done.

00:25:36: Second thing, patient safety depends on quality of the quality, of the clinical report.

00:25:44: This is very important.

00:25:45: for example I've got lots of friends that are ophthalmologists.

00:25:49: i don't know if you've been to an ophthalmoleges before.

00:25:51: yes okay?

00:25:53: If you read a clinical rep or an opthalmology it's full of letters without knowing this.

00:25:59: and maybe someone who's not a doctor... It's impossible to read your clinical reports from an ophtalmologist.

00:26:06: All this with this transcription system has changed.

00:26:09: It's clear language for the patient, and again safety is much better because other doctors will understand much better And you as a patient will understand your clinical report under recommendations and treatment.

00:26:24: And here in Kiran Saluth, I see that you're really at the forefront of innovation.

00:26:28: That's why i would also like to jump on to advanced robotics because you have also had the Da Vinci surgical system as one a very prominent example here in your houses.

00:26:39: for listeners who may not be that familiar with it this is one of the most advanced surgical robots worldwide that has been designed by NASA engineers and that allows surgeons to perform really minimally invasive procedures.

00:26:55: how has that introduction of surgical robots basically changed and hopefully enhanced outcomes for patients at your hospitals?

00:27:04: Well, very much.

00:27:05: We've got thousands of examples.

00:27:08: actually in this hospital we perform more than three thousand five hundred patients have been operated with Da Vinci Robots until now.

00:27:18: besides Fundación Gimenez Diaz Both of these hospitals, we have three Da Vinci robots in each one.

00:27:24: We're the first hospitals In Madrid to have so many robots.

00:27:29: The company Kiron Saluth is betting on this system Because it's much better and lots of technical surgeries To do this system.

00:27:38: Why?

00:27:39: It would be probably better for a surgeon to answer that question But mainly... ...to use robots means you need smaller surgical area to get in it so this is much better for the patient's recovery.

00:27:54: This is great for urology, this is great otorhinolaryngology because there way lots of things can be done through throat not needing cut any bits on your neck or face.

00:28:08: It´s much better and much less invasive for gynecology than general surgery.

00:28:16: thoracic surgery again, if you need to get something from your lungs are much less.

00:28:20: So mainly DaVinci robot.

00:28:23: what it makes is people to be operated in the same time because once the doctors know how to use them they used the same or less with a less invasive system and that means much more quickly.

00:28:38: For example, in this hospital we're starting to do emergency surgery medicine with Da Vinci where the second hospital is Spain.

00:28:48: that starts.

00:28:50: it's a bit more broader and United Kingdom.

00:28:54: But for example, a patient with that needs a cholecystectomy because the patient has a cholycystitis by Da Vinci.

00:29:02: The recovery one to days versus seven days in hospitalization.

00:29:07: so again In terms of sustainability of this system is better.

00:29:12: Of course if you only take a look at the actual price of doing the surgery.

00:29:18: Yes I can assure You That it's much more expensive right now a surgery with the robot, that's a surgery without the robot.

00:29:25: But again it is priceless if you take a look at global process of patient number of days he has or she had to stay in hospital for recovery and of course they're patient experience about being operated one way or other.

00:29:40: Here we've got the best doctors I would say Europe using robots.

00:29:46: We have doctors coming all over Europe on North Africa to

00:29:53: get

00:29:53: trained here in different fields.

00:29:56: And it's actually an honour, being a hospital with such high quality of this system.

00:30:03: Because when we entered the building you nicely showed us around obviously... You also commented on one leading architect who has been designing this and kind of the concept behind that right?

00:30:16: So probably can share because I was impressed by other countries like even China that are also at the forefront of innovation, and now coming to Madrid into your hospital.

00:30:26: To get inspiration here?

00:30:27: Yeah

00:30:27: it was done by Raphael de Laos who's a great architect really famous architect.

00:30:33: The idea or concept he wanted when he built this hospital is very simple.

00:30:40: That's a good start.

00:30:42: Yes, because he had the feeling or I've listened to him about the explanation that lots of times when you get into hospitals it can be real nightmare getting where do want go.

00:30:53: so if take look at how in hospital is like our main road and from the main road quickly access every single bed.

00:31:13: Another area where current Saluth is also very active in, research.

00:31:19: You're holding yourself as a group of thirty patterns.

00:31:22: you have more than a thousand active clinical trials ongoing.

00:31:25: so basically my question I would say it's two-fold.

00:31:27: first what are the most promising projects your research teams currently working on and give us kind of sneak peek into that?

00:31:37: And secondly i'm curious how do leverage AI for R&D?

00:31:41: because you have a lot of the data available digitally.

00:31:44: You have AI capabilities, it seems in-house.

00:31:47: What are the advantages that your already seeing from this on the ground with regard to speed position or even also making better choices?

00:31:57: First I

00:31:59: think part of our goals and parts of our score and soul is not only about healthcare delivery.

00:32:07: Of course there has to be activity, a hospital has to do.

00:32:12: But for us there's also two things that are really important because if not we will not be better.

00:32:18: and remember one of the things we thought at the beginning is We have to do things differently And we have to be better than what we used to be.

00:32:25: and these two things our teaching Our research which truly believe about teaching all types of universities, the residence program obviously.

00:32:36: But of course research.

00:32:38: here we've got El Instituto Fundación Humanidad it's one of the best research institutes whose leader is la doctora Ayuso and I think this has been a key point in the last because this also attracts doctors are willing not only to do health care delivery, but also about doing research and teaching.

00:33:02: And this is a key point about it.

00:33:06: one thing that has been game-changing Also in the last years as all these innovation tools you were mentioning before All the ways of Doing things differently in management style have been published.

00:33:20: we've published all these Innovation ideas clinical prestigious papers that, by the way they've done different bits inside their publications only for healthcare management and innovation.

00:33:35: So we've published in BMG a catalyst of New England Journal Medicine and Lancet so many of them on.

00:33:44: it's one of our purpose to keep publishing these papers.

00:33:48: That's very nice to hear.

00:33:49: And probably zooming out a bit, Kieran Saluth is also obviously part of the Fresenius and also Helios group which has network that spans Germany Spain but also Latin America including growing presence.

00:34:01: I learned in Colombia.

00:34:03: How does international structure benefit patients on ground?

00:34:09: Clinicians are there deliberate strategy that you're transferring best practices from one hospital to the other, From One Country To The Other because You are doing a lot of kind Of Research And Experiments In Some Of The Places That Other Physicians But Also The Patients Ultimately Should Benefit From What's Your Thinking On That?

00:34:28: Obviously

00:34:28: Yeah.

00:34:29: Yes I Like Saying That Diabetes Is Exactly The Same In Berlin Than in Madrid and Washington.

00:34:36: For Sure

00:34:38: The Illness is Exactly The same.

00:34:40: maybe thirty, forty years ago when the pharma industry wasn't so globalized.

00:34:46: Maybe treatments could variate a bit between them but nowadays there shouldn't be big variation.

00:34:55: and again yeah we're doing.

00:34:57: of course sharing.

00:34:59: The projects were done here in Germany is double benefit for all of us And we've started to do different programs of doctors from Germany that are coming into Spain and doctors from Spain, they're going to Germany.

00:35:15: Again if we manage because we are doing special groups working all together... If this was one the key points for success years ago where engineers doctors management teams could get onto it well why not?

00:35:30: Doing these things between German and Spanish teams, this way will be the at least most interesting company in healthcare delivery.

00:35:42: In Europe or in the world?

00:35:44: So we actually started off this episode discussing the growing relevance of health tracking devices for many people including obviously ourselves as we shared which is part of a way larger transformation healthcare systems towards more preventative personalized system and one that is less disease-focused.

00:36:05: At the same time, we're at a hospital which is kind of the embodiment of disease care in a traditional healthcare system.

00:36:12: In your view how will the role of hospitals change in future given that health care more and more happens also outside of designated locations like clinics rather integrated into our everyday life, because what I also learned is that on average throughout the globe we're spending about thirty minutes per person with a doctor annually which is kind of maximum where bug fixing happens right but not where healthcare's catered for.

00:36:43: What's kind of changing role for hospitals in this?

00:36:47: This was probably the most important point.

00:36:51: What we said there was, it's not about digitalization on its own.

00:36:55: It is a health care cultural change.

00:36:59: We cannot do individual acts.

00:37:01: I mean...we can't treat you as patient only when you come in hospital.

00:37:06: If we do this As system?

00:37:08: We fail.

00:37:09: Yeah!

00:37:09: You cannot treat your stroke Obviously that shouldn´t be our goal or heart attack.

00:37:20: This can happen, and we have to treat you after you leave hospital because... ...we have to treated the whole process.

00:37:28: We cannot treat just an individual act.

00:37:31: If this system only treats an individual Act The system will fail Because a number of cases are rising up.

00:37:40: So for us.. ..we changed it And were always seeing lots of talks laughing a bit because we're always talking about before, during and after.

00:37:50: But it's true!

00:37:52: We've done loads of prevention campaigns... try and treat you before you come while your in hospital, after you leave.

00:38:02: This is the main point... And actually digitalization.

00:38:06: what has been useful to be able do this?

00:38:09: because thanks to digitalized senses we've being able to treat you Before You Come once at home or After You Leave Hospital.

00:38:17: but that's a key part of our strategy inside Kiron Saludio.

00:38:22: And in order to make this a reality, what we believe and I personally also strongly believe is that there will be increasingly kind of a convergence of stakeholders within an into health care.

00:38:35: Because if you really want cater for patients being or people not patients the first place but people being prevented then you would need to entrench healthcare into their homes, there way-to work at the workplace.

00:38:50: However this is where health care preventative health can needs to happen which means that he wouldn't need an ecosystem kind of wear a hospital.

00:38:59: it's collaborating with diagnostics companies with retail consumer company Producing food and the delivering at home where you're having a farmer companies in others building up solutions And this ecosystem is then embedded into everyday life into twenty four seven.

00:39:18: But this would mean that stakeholders traditional health care stakeholders, but not so traditional healthcare stakeholders Converge their interest around the very person, right?

00:39:27: Fully

00:39:27: agree.

00:39:28: And I'm sure that's what we're going to be seeing in the next five years or less two years because things like That already happening.

00:39:36: We created our own ecosystem surrounding around a cassiopeia which is our own system on the patient portal.

00:39:43: This was The first point.

00:39:45: of course there are lots of tools Right now being done and delivered by engineers companies startups company a great idea that developed, and we have incorporated inside our system.

00:40:00: The only thing for us is it has to be inside Cassiopeia – inside the system!

00:40:06: Why?

00:40:07: Because if not then we would have one hundred apps.

00:40:11: but I fully agree... stakeholders are going to, already in the market.

00:40:18: The thing you said about food.

00:40:20: I think that's gonna be one of the key points for the future.

00:40:24: Well it is already present!

00:40:26: Thank You so much Hoche for sharing your expertise and giving us this really incredible look inside one Europe's most innovative hospital networks.

00:40:35: It was great meeting you here in Madrid.

00:40:37: Thank you very much for coming, taking your time.

00:40:40: It's been a great pleasure.

00:40:42: I liked the conversation and hope it is useful And

00:40:49: thank-you to everyone joining us today!

00:40:52: I really hope that you like this conversation as much as i did.

00:40:55: Please do not forget to rate our podcast on the platform of your choice because your feedback & support is what keeps going.

00:41:02: Until then... Take care and stay safe, or as they say here.

00:41:07: Hasta pronto!

00:41:10: Strategy and strategy

00:41:12: made real.