Dr GENÉ: Libre elección de hospital en el sistema público

2 07 2012

Dr. Joan Gene Badia

Editor del Forum Clinic

Doctor of medicine and specialist in family and community medicine


Entre la obcecación de unos por introducir recortes y la de otros para evitarlos van pasando los días de la crisis. Surely I'm not the only one to think that we are missed another great opportunity to improve our health care system. It's a model that has not changed substantially since the 1980s and that today not attends properly the needs and expectations of citizens. We are not only older and suffer more chronic diseases, but also we are better informed. We want to be more independent. New technologies help us to connect and to participate more directly in the decisions that affect us.


The great change that requires our health system is not a purely technical question, but it is a true Adaptive challenge. The solution to the current health crisis will emerge from the collective intelligence of those affected, in this case, citizens and professionals.


For this reason I would like to contribute to the social debate the proposal that there is a free choice of specialist and hospital in the public sector. The measure is not capricious or due to ideological positions neoliberals. Unlike, It is a vital decision to advance in clinical safety and the efficiency of the system. It is surprising that all hospitals, even those who maintain a modern and liberal discourse of the management of public services, in the twenty-first century Catalonia, are comfortable with a captive customer environment designed for the society of the 1980s.


The report of the Central Catalan results1 It shows that there is between centres a great variability in income and the surgical mortality. As usual, the volume of clinical activity is associated with security, and the variability of the results alert on quality issues.


The demands of transparency and clinical safety demanded by today's society makes anachronistic this monopolistic situation of Catalan hospitals. If politicians do not react rapidly increasing information on the quality of the services that provide and allow patients to choose hospital, will be the same population which required by. It is a little understandable that a citizenry that demands a more direct democracy continue to accept for much longer that their health care come marked by bureaucratic and administrative criteria.



1. Generalitat of Catalunya. Report as of the Central of results. Departament de Salut Generalitat de Catalunya. ( Accessible the 29/6/2011 in www.Gencat.cat/salut/depsan/…/central_resultats_segoninforme_2011.PDF)


Sra ESCALA: Innovación de garaje en la sanidad española

3 10 2011

Elena scale Sáenz

Diariomedico.com Chief Editor

Microsoft, Apple, HP, Google… All these companies have in common that they were put in place, either literal or metaphorically, in a garage. Is to say projects that sustain them were developed outside of the Establishment, as a voluntary activity, amateur and collaborative. Projects, In addition, in those who has invested much time and effort.

These success stories have made think to some institutions and public administrations to an idea, a garage and a couple of free hours after work enough to innovate in any sector, including the health. Belief that also relies on the idea that Internet and Social Media are the guarantors of the innovation of the 21st century.

Until recently the innovation related almost exclusively to the elite, above all institutional, What was supposed to enter a highly regulated circuit, conservative in thought and resources, rigid and little given the risk and improvisation.

Outside these circles it was very difficult for the healthcare professional to find the technical and strategic resources to innovate. Where do I call?? There is a service of attention to the innovative?? A few yellow pages?? Who helps me to develop my idea??, wondered.

This lack of information and resources has caused the failure of a company on more than one occasion. In fact, more than half of Spanish companies are failing for financial reasons, by errors of calculation; but the percentage of failure attributable to the lack of experience or knowledge in the professional field is very low.

This portrays very well the situation of the health care professional, account with knowledge and an excellent preparation, but it is with problems when developing their ideas either because you don't know the business tools and management, or because you do not know how to obtain resources.

Although making them this traditional circuit of innovation is going flexible little by little, only the Web 2.0 It has been able to produce a substantial change, democratizing the innovation process.

Thanks to Internet and its viral nature an individual, If you already know operate in this complex framework Cyber, You can undertake and innovate outside the usual circuits. Increasingly there are more tools to display, extend, promote and finance their ideas getting their projects to be productive and profitable.

We are even beginning to see the figure of the intraemprendedor in health, the professional still working on behalf of others in a company or institution, use innovation and creativity to develop projects or products originating small start-up that your company, that usually works for which, is the main investor. I.e., the entrepreneur is in your company to his main ally.

So emerging successful telemedicine projects, virtual consultation, management of chronic patients, reduction of bureaucracy, training, social networks for the exchange of knowledge, projects for health promotion…

There is a roadmap of innovation and we do not know what keys that guarantee success. But the truth is that when any of these health garage innovators has success in the development of your idea, the system comes out winning. And however, that effort is not always compensated, recognized or supported by the system.

It is a mistake to pretend that innovation in health is based almost exclusively on innovation in garage, in many small efforts not rewarded or supported.

Projects that health care professionals are launching individually or collaboratively must necessarily be in business agendas, institutional and academic, having a real impact on public health policies.

It is not enough with the will to innovate, and not all Spanish professionals have a garage. Es imprescindible un compromiso serio de todos los agentes que conforman el sector sanitario.

Dr Pike: The "industrialization of medicine"

7 02 2011

Dr. Josep Manel Picas Vidal

Director de Sistemes i les TIC l’Hospital de la Santa Creu i Sant Pau

Health practice, is subjected for many years, to a discussion that has more or less radicalized supporters, in its two possible approaches, It is a science or an art?? Sure we would find arguments in favour of both concepts, on the one hand, the necessity of applying scientific knowledge, one that is based on the cause-effect relationship, in evidence of results or comparative analysis with statistical robustness; However we can use arguments underpinning the second approach, the necessary creativity, the intuition to consider with different weightings, a set of variables which ultimately lead us to make a decision or successful therapeutic diagnostic performance.

Probably, This topic, It lies at the base of the little progress that we could call the industrialization of health practice in general and in particular of the medicine, understood as the standardization of processes that seek to obtain a result encompassed in a product called health; at this level it is necessary the use of technologies of the information and communication; However, If we compare it with other sectors the advance is exasperadamente slow, If take into account tools, with all its potential and actual costs are already here.

It is difficult to conclude the reasons, We could point to some: the great intervention of persons in the process (more than the 75 % global health costs, in hospitals and primary health care are devoted to give back to human resources, most of them highly qualified), the large number and complexity of processes involved in a particular health problem,and the consideration that ICT spending is an investment postponable (much more in times of restrictions on spending)

However, some favor wind begins to blow, the need to make less bureaucratic, of re-ingenierar and optimize processes (early introduction of methods such as LEAN production systems or Six Sigma) and perhaps the most powerful: the need to "do no harm" that would continue to the concept of quality and patient safety. Both seem to be that they are taking initial steps, It will demand deep change management policies, If you do not want to get delayed or anchored by inertia and sometimes the resistance generated by the intervention of a large number of people, with a high variability of roles and knowledge.

At last, comment that it is absolutely necessary to promote and promote new initiatives, that put us on the right path and at the same time serve as a bed to generate the necessary cultural change, for the emergence of new and more advanced proposals.