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EF: In the post-Covid times, executives must deal with complex multi-faced economic and political scenarios. How do you visualize 2023; do you see it as a challenge or an opportunity?

AZ: There are many opportunities, yet they do not come without challenges. Our main goal and purpose are saving lives and improving the population´s health and quality of life. However, as in most developing countries, Mexico still requires increasing the penetration of innovative technologies. At this point, delays in the regulatory approval process are the main issue. They do not affect our growth significantly, but the lack of new technologies is increasing the access gap and creating an opportunity cost for the system that cannot capture the value for patients and the healthcare ecosystem overall in economic and social terms. The situation has become critical over the last few years, and we need this problem to be remediated by changing the trend in the regulatory process. Digitalization and adopting equivalences and reliance can make the approval process more agile and efficient, as other regulatory agencies across the region have shown.  

From the financial perspective, inflation and currency valuation impact look better than we expected last year, which means less pressure on the prices and margins, creating a positive scenario for the rest of the year. We still face some uncertainties in the public acquisitions sector, but things quieted down compared to the end of last year. All our efforts are focused on our transformation to be more efficient in bringing innovative solutions that increase access for more patients.

EF: Could you elaborate on your footprint and portfolio within Mexico and how it has evolved?

AZ: I feel very fortunate because things are going very well at Boston Scientific, with strong growth compared to pre-pandemic results. I came to Mexico in March 2020, and that first year was exceedingly difficult to keep our team safe, our financials under control, and not stopping to assist life-threatening cases. However, in the last two years, we rebounded, with high double-digit growth in most of our therapies and gaining productivity. In 2020 we accelerated our investment in digital transformation, looking to the next five years and strategically planning for the future, and now we are harvesting the results of our foresight. The culture of value improvement process has helped a lot to create automatization and eliminate some redundancies and inefficiencies. In alliance with strategic customers and channel partners, since last year, we have implemented value solutions like a blockchain-based secure system to make inventory replenishment and invoicing more agile and touchless, reducing operative costs, time, and reprocessing delays and associated costs for errors in manual transactions.  

Since last year we also accelerated remote solutions, a pre-pandemic initiative we were incubating. During the pandemic, with the restrictions to access hospitals and travel constraints, we adopted remote solutions for training and procedures supported by our team and external proctors. Since then, we have been expanding the use cases to other needs, from remote congresses and meetings to technical and clinical assistance for individuals or groups. This technology is still in its infancy and has the potential to create more access in remote areas and enable more productivity for healthcare providers.  

I learned that we need to fall in love with the problem, not the solution. Today there are many new and very attractive technologies like AI, NFTs, Blockchain, IoT, etc.. that we need to understand very well in order to leverage our processes. However, we must always be clear on solving the problem that matters most to create value for customers and the company.  

In the healthcare sector, we are catching up in adopting many well-used technologies in other industries. The challenge is to be smart with the investments, stay focused, and channel resources wisely to make a meaningful impact and get the expected return. When we think of data-driven processes, we learn that creating the culture and discipline necessary to register meaningful information and complete the processes to extract and use the insights that enable better decision-making is time-consuming. Nevertheless, in the end, it is worth the effort to build better and personalized customer experiences and identify the opportunities that are better satisfied with the company resources. At this point, people don't work for the tools, but the tools work for the people.  

EF: From a leadership perspective, how was it taking over at such a difficult time?

AZ: I landed in Mexico on March 8th, 2020, to take the role, and two weeks later, Covid 19 broke out with all the implications we know. Generating personal connections and building trust remotely was a great challenge. Being highly focused on people and their emotional and fundamental needs comes naturally to me in face-to-face interactions. Still, it was only feasible to resume such activities in person a year later.

I've learned that in difficult times it's crucial to focus on three key aspects. Firstly, it's important to maintain a calm and rational mindset that enables clear thinking and helps prioritize tasks to ensure business continuity. Secondly, it's essential to lead with empathy and consider the impact of every decision on people. Lastly, one must have a hands-on approach and fully engage with the reality of the situation. In my case, I held daily remote meetings with small groups of collaborators and had random one-on-one meetings to stay connected with the team. I used every opportunity to connect with team members and understand their situations personally.  

EF: Could you elaborate on how Boston Scientific collaborates with other stakeholders in the sector and how you leverage your AMID membership to collaborate and help for the benefit of the good?

AZ: AMID is the entity that represents us as a sector and where we discuss common needs, challenges, and opportunities to increase access to innovative technologies for the benefit of the Mexican population. We are actively involved in syndicated decisions and daily participation in committees such as compliance, access, and regulatory, among others, where our collaborators play a key role in driving initiatives forward.

We also learned that collaboration among different organizations within the ecosystem is the best way to reach higher, faster, and even unexpected goals more efficiently than alone. We developed alliances for education with hospitals, investing in simulation centers (i.e., CESME at Hospital 20 de Noviembre, CESME at HRAE in Medida) to train physicians in new technologies and techniques; or the agreement with the UNAM to train physicians from different specialties from pre-grade to postgrad.  

One of our strategic imperatives is related to education. Education is the most important single driver to create social mobility, people empowerment, and open opportunities. A big part of the gap in healthcare access in Mexico is related to the asymmetry of knowledge at different levels in the ecosystem, which creates disruption and/or delays in the patient journey, with consequences in the quality and quantity of care; in other terms, the value delivered.  

We have various collaborations and are actively looking to complement our capacities with companies that also need ours to improve patients' lives. We cooperate with private companies like Previta, a Mexican company that provides telemedicine for patients after interventions to reduce the need for multiple visits, providing the relevant paraments to the doctor in real-time.  

Another partnership we have is with Consorcio Mexicano de Hospitales. We choose medium-sized institutions to facilitate training for their personnel to make the workflow more agile and effective for their patient journeys from the first to the third level. These alliances aim to make both parts stronger and more valuable for the customers and enable a better experience for patients.  

EF: Your current production comes for Costa Rica and Puerto Rico, but with the opportunities in nearshoring and other trends, can Mexico potentially become a manufacturing location for Boston Scientific?

AZ: The global facilities team is leading the strategy for manufacturing sites, and I still need more information on the future plans for Mexico. Mexico is already the eighth exporter of medical technology worldwide and has the potential to grow. The country is very attractive and might capture a great part of the nearshoring strategy from different industries, including medical technologies. However, the local conditions must be favorable and stable to materialize this.  

EF: If you had to create your own startup company tomorrow in the Mexican healthcare sector, what would it be and why? The  

AZ: My priority would be prevention, as the current healthcare system is at risk of failure in various regions worldwide. Instead of addressing issues as they arise, we should prioritize preventative measures. This is because the demand for healthcare services is increasing at a faster rate than the resources available to meet them. We must go to the roots and empower the population to stay healthy. We must leverage the data and technology to create new meaningful innovations to prevent or anticipate healthcare issues to treat them earlier if needed. A big reform for digital health in Mexico would bring value to the public sector and allow us to find the highest unmet needs. However, it is worth starting small and then escalating when all enablers are available. There are already many startups working on changing people's habits using AI to improve nutrition, mental health, sleep habits, etc., that will make an impact.  

EF: Our feature is called "Road Map to the Future," so if you had to create a road map for the healthcare industry in Mexico, what would be your three base pillars?

AZ: My first pillar would be creating trust among all private and public stakeholders. We must agree and commit to long-term goals, be transparent, and consider the benefits of the individual parts and the results for the system overall; this is the base for value-based medicine.  

My second pillar is patient-centricity. "The patient will see you now" is an interesting book by Dr. Eric Topol that reveals patient empowerment and the shifts we will face in the dynamic of the healthcare ecosystem. The pandemic has accelerated this process, making people more aware and getting involved in their health. When patients visit a physician, it is highly probable that they have already done the research online and might even bring a self-diagnostic. Physicians and healthcare companies need to recognize that patients are increasingly knowledgeable and empowered. While they may not always be well-informed, they still deserve transparency and to be treated as important stakeholders in their own healthcare. Therefore, patient-centricity must be for more than just the marketing slides. It has to be real.  

My final pillar is people collaboration, and this expands to building communities. I see the world as a closed system affected by our decisions, with positive and negative impacts and multiple trade-offs resulting from our interactions. As Francis Fukuyama mentions in his book TRUST, "nation well-being, as well as its ability to compete, is conditioned by a single, pervasive cultural characteristic: the level of trust inherent in society." Furthermore, he also highlights that "the most effective organizations are based on communities of shared ethical values."

May 2023