Enrique Ruiz Escudero – Minister of Health, Community of Madrid, Spain

Enrique Ruiz Escudero, Minister of Health of the Community of Madrid, discusses his strategy to maintain Madrid’s spot as having Spain’s leading healthcare system, the creation of the bio-region –‘Biomad’, and the city’s adoption of innovative telemedicine practices.

You took the reins of the Ministry of Health of the Community of Madrid (Madrid MoH) in 2017, almost a year ago. What has been your mission and what have been the most significant actions taken in the past year?

Taking the reins of the Madrid MoH has been both a challenge and an opportunity. Here in Madrid, we have the best quality healthcare in the country as well as in Europe, according to our data.

Madrid has 6.5 million citizens and we have a network of 34 hospitals, 430 health centres and 71,000 staff, including 16,000 doctors. Managing and maintaining such a large network is obviously a challenge. We are the region with the highest life expectancy in Europe at 85.2 years and this forces us to stay on our toes, always innovating, and making sure that we maintain the best management possible.

We are the region with the highest life expectancy in Europe at 85.2 years

The total Madrid Community budget is more than EUR 19 billion and the Madrid MoH represents 41 percent of this – highlighting the strength and the importance of healthcare here.

We have been focusing on four principal challenges:

The first challenge is human resources management. We established two new measures, the most important being the public offer of jobs, creating almost 20,000 employment opportunities. The other measure was the reorganization of the remuneration of our staff so that their pay level is accordant with their level of experience and expertise. With this measure in place, our healthcare professionals will feel inspired to pursue the academic investigative part of their work and their personal merits will be reflected in their paychecks.

The second challenge has been putting in place an infrastructure plan. Many of our hospitals, generally the most complex ones, are several decades old. As the concept of patient attention and health has evolved, our hospitals also need to evolve. We have an investment plan of EUR one billion over ten years through which our most important hospitals, including Gregorio Marañón, Niño Jesús and La Paz, will have the update they need and deserve.

The third challenge is the ongoing process of management improvement. We come from a healthcare model where the hospital was the centre, but we have moved to a more holistic model whereby the patient is cured and cared for not only by the doctor but by all of our medical professionals. Healthcare needs to be where the patient is because the patients’ opinions count and they need to feel more autonomy for their own healthcare. All of this demands a great deal of attention and constant change in all our processes.

The fourth and last challenge is research. As a region with numerous universities that attracts enterprise, we had to establish a strategy to promote translational research and make the scientific work that we do here count. That is the rationale behind the creation of the ‘Biomad’ Madrid bioregion project – we want to create a network between the Ministry, the universities and all industries, not only pharmaceuticals but anything related to health, and find more investment, encourage competition and collaboration.


How does the Madrid healthcare system differ from that of other regions of Spain?

I think the most important difference is the strategic geographic position of Madrid, being in the centre of Spain, with 810,000 hectares, 6.5 million citizens and a density that increases considerably the closer you get to the centre of the city.

We have a network of 34 hospitals, including some of the most important and complex institutions in the country. Additionally, the Community of Madrid has the most national Centers of Reference of any of the regions, which is a significant draw factor for professionals and specialists.

Our transport network is rated as one of the best in Europe, it takes one and a half hours to drive across the region; this network helps make our urgent and primary care incredibly fast.

An additional factor is our management model, which allows for collaboration between the public and private sector. Around 20 to 25 percent of our activity is done with our supervision but with private management. This allows for homogenization since our indexes are similar, patient satisfaction is high but also allows transparency in each process. It keeps us in constant check.

Madrileños feel proud of their health and it’s a value that defines us.

Above all, apart from having great public healthcare we also must recognize Madrid is very attractive for the private health sector. Let’s not forget that even if they’re smaller in size, there are approximately 65 private hospitals, the biggest and most important enterprises in private healthcare operate from here, that helps us be in this level.

So, in short, what makes us stand out is our great geographical position, the great infrastructure, the management model which allows great mobility and homogenization between public and private, and an ever-transforming health policy.


The ‘humanization’ of the healthcare system is another of your priorities. How do you define this term and what changes have you been making to achieve this?

Humanization encompasses everything around the organization’s attitude and actions to healthcare. It means reclaiming the professional-patient relationship and not allowing technological advances to make us forget what our patients think and feel. This encompasses everything from the moment a patient walks into any healthcare institution until they leave – whether they are in urgent care, in a consultation, in a waiting room, or if they report side effects of their medication. We need to inform patients and create professionals that can build and strengthen that relationship because the better our professionals are in humanization, the better the results are for the patient.

Before we had patients that would not talk about their symptoms or diseases, now we are seeing people being more open towards our professionals. Of course, we must recognize the importance of patient associations. We have a very fluid communication through the Dirección General de Humanización which is important because this push for humanization cannot only be a philosophy, it needs to be translated into administrative decisions.

We have indicators for humanization at the professional, patient and structural levels. We have even established a patient observatory, whereby we interview over 46,000 patients about their level of satisfaction regarding urgent care attention, primary care, the hospital itself, treatment, and waiting times. After all, that is what humanization is: optimizing all the processes that the patient goes through.


You recently announced an upgrade plan for the hospital infrastructure in the Community of Madrid. What are its characteristics?

Certainly, in the years to come, we have a lot of activity regarding infrastructure. The La Paz Hospital is going to be a new hospital in 10 years, at Gregorio Marañón Hospital we are creating a new surgical wing and an oncological wing, all of which also means an upgrade in equipment. Furthermore, thanks to a generous donation from Amancio Ortega [Spanish businessman and the fifth wealthiest person in the world – Ed.] we will incorporate 13 linear accelerators. And we will create a new regional plan for robotic surgery with the DaVinci robot. On top of that, we will carry out a study to establish which of our teams’ medical equipment needs to be updated most urgently.


In terms of the Madrid MoH’s relationship with the pharmaceutical industry, what type of innovative collaboration models are you considering using?

Approximately 12 percent of the Community of Madrid’s budget and 29 percent of Madrid Ministry of Health’s budget goes into the pharmaceutical industry, which shows its size and importance. Madrid has a large amount of pharmaceutical companies, both nationals and multinationals. What we must do is have strategy regarding the rational use of drugs, which is something we’re always working on, and the key is innovation. We, associated with Biomad, have noticed that the knowledge regarding pharmacology is growing at a very significant rate. The most important example of this is Hepatitis C. Madrid is exemplary in this area, treating more than 20,000 patients with a success rate of 94 percent.

What we want is a partnership with the pharmaceutical industry; not being just clients.

What we want is a partnership with the pharmaceutical industry; not being just clients. We want to see how the innovation works from the healthcare point of view and above all, have our sights set on the horizon of sustainability.

We have extremely high expectations about the potential of Biomad and the strategy for advanced therapies. It is bound to be a quantum leap and will channel all the potential that Madrid has with that stimulus that the pharmaceutical industry wants to give to medical trials and innovative studies.


Which is the role can telemedicine play in Madrid in maintaining the sustainability of the system?

Telemedicine can play a major role. We have many examples for telemedicine, but the one of attention to institutionalized patients might be the best; the Puerta de Hierro Hospital is in the axis of the Coruña highway, which is a zone with many elder citizens in nursing homes. The hospital had many patients coming in from these nursing homes and the stays were too long and treatments didn’t seem to be improving, so we created a geriatric service (as we have now done in all the hospitals of Madrid) and the hospital team met with the medical directors of the homes (approximately 150 homes with nearly 6.000 patients).

What was achieved was a telemedicine system; the doctors from the hospital have video conference calls with the home and the patients to determine if there is a need to transport the patients to the emergency room. If there is, there is a special room for our geriatric patients, this has had a huge positive impact on waiting times. The doctors from the hospital also asses if the treatment in the home can be improved or if there is any need to bring treatment to the home. Following these measures, establishing a very concrete path of action, the savings come up to EUR nine million after only a year.

These are measures where technology is key, we are now thinking of telemetry and monitoring vital signs remotely, all these things are now in the way we work.


What about big data?

Medical records are very important. The process of establishing electronic medical records has been a long one, but we are only two hospitals away from finishing and on primary care, it is already working. We are trying to give the professional as much data and as many tools as possible. We are working with IBM to measure more data and be able to establish predictions from it, having everything in the medical records. Of course, the biggest goal is to unify the data between public and private healthcare.


What does the Community of Madrid expect to achieve with the Biomad initiative, scheduled to be established before the end of 2018?

Biomad was a necessity, there are many regions in Europe where this kind of strategy is already established. We created a group where they established the fundamental idea of Biomad, we commissioned a consultor group to do a study of the current situation of research and innovation in the Community of Madrid, the country and the private sector. There, we included universities, enterprises, and foundations. Once we have the results we want to launch a strategy, defining our goal. To maximize the collaboration between these actors and encourage competition to optimize the quality and the rate at which we innovate, bringing more investment and making a brand out of Madrid being a bio-region.

After that, we want to create a strong directive board that can move around the world to bring in more attention and investment from the public and private sector to boost even more research.


What would be your final message to our readers?

Madrid, within the national health system, wants to be a pole of attraction to all the companies in the healthcare sector. We want to bring more innovation, more investment and above all, more well-being to our citizens. We will keep improving our processes, making our professionals feel good about their jobs and the patients feel better.

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