Read the Conversation

EF: May you give us a brief overview of the hospital landscape in Brazil? 

MP: Medicine is innovation. Probably, the healthcare industry is the one that invests the most in innovation and technology. The exponential growth we are seeing in healthcare in this last century is not seen in other sectors. And Brazil is not behind – we are seeing remarkable technological advances, with well-developed ER systems and efficient data lake standards for seamless patient data collection. However, a significant challenge persists in interoperability among major companies like Hospital Moinhos de Vento. This disconnect leads to insurance plans needing crucial patient information beyond financial data, impeding medical collaboration. Hospitals remain unaware of nearby medical facilities and patients' activities, indicating a dire need for improved connectivity, intelligence, and patient-centered perspectives. This issue is not exclusive to Brazil, as other nations face similar challenges. And there are challenges from an innovation standpoint, too, because it's quite expensive. Only the bravest seek to purchase all the new equipment as soon as it appears. We have to offer the products to patients, but we don't know if there will be patient compliance. So, innovation is an act of courage at first. 

EF: From your and the hospital's perspectives, do you see this year as a challenge or an opportunity? 

MP: The current situation poses challenges and opportunities for enhancing the quality and efficiency of healthcare services. COVID-19 has profoundly impacted hospitals, leading to financial losses, reduced patient interactions, and increased employee turnover, disrupting established methodologies and procedures. As a result, our hospital and several others are reconstructing their culture through comprehensive employee training. Post-pandemic, it is evident that patient behavior has shifted, reflecting heightened health concerns and a change in medical needs. This is not limited to our region but is evident internationally, requiring attention to address the evolving landscape. 

The financial calculations for insurance plans currently overlook certain risk structures. Many patients have chronic conditions not adequately managed during COVID-19; others still suffer its consequences. As patients prioritize their health more, preventive measures are encouraged, but communicable diseases must be reconsidered. This poses challenges for insurance companies as their medical expenditure nearly matches revenue, leaving minimal operational profit due to high-interest rates. Despite making money through interest, the need for more surplus creates a significant hurdle. Hospitals facing full capacity and insurance companies reporting losses underscore the importance of reevaluating relationships between insurers and healthcare providers. 

Post-COVID, insurance companies seek to renegotiate price conditions with families and businesses. However, there are limits to what they can agree upon. Healthcare providers must now adapt to be more cost-efficient and deliver higher-quality and safer patient care while providing better visibility into the future. Collaboration is essential as we function as a system. 

While verticalization brings challenges, it also presents opportunities to learn and improve. Though complete verticalization has drawbacks, it can demonstrate more efficient care pathways. The situation is a mix of risks and opportunities, urging us to embrace change and grow for the future. 

EF: Looking back at the unprecedented times from a leadership perspective, how do you reflect on the greatest lessons you learned through the pandemic? 

MP: As I transitioned from CFO to COO and eventually CEO, my management perspective had to evolve to focus on people, strategy, and the future. Gaining the trust and support of a vast team of over 5000 employees was a significant challenge we overcame together. However, COVID-19 disrupted our progress, causing a loss of culture, processes, and valuable team members due to high turnover rates. 

Amidst the ongoing challenges of the COVID process and its consequences, we've experienced the goodness and strength of humanity. Being in the healthcare business during the pandemic was both unlucky and rewarding. We played a significant role in saving lives, receiving patients from across Brazil, lending equipment to public hospitals, and supporting research on COVID treatments. This experience taught us the importance of people, methodology, and culture in building a lasting business. Now, we are investing heavily in a cultural project and comprehensive training to engage our team and increase retention rates, thereby maintaining our delivery of exceptional quality care. 

EF: Could you elaborate on the footprint you have and the role you play as part of Porto Alegre’s health infrastructure? 

MP: At 95, our hospital has a rich history rooted in a German community. Through collective efforts and contributions, they gradually built the hospital over 30 years, accompanied by the creation of a school. We have a group of directors – some more dedicated to strategic and future projects, and others to current challenges. This approach ensures both short-term effectiveness and long-term resilience. 

We aspire to become the leading hospital in Brazil in terms of quality. Our goal is to redefine healthcare in Brazil and be the best hospital in the country within the next ten years. We will invest everything we can in what is best for our patients. Although we are a private hospital, we are also a not-for-profit institution. Any surplus we generate is reinvested in our hospital, and about 50% is allocated to supporting the public sector, particularly the Unified Health System (SUS), which serves as Brazil's public health system. We aim to be the best in the country. Despite starting in 10th position, we have climbed to third place in this vast nation in Newsweek magazine's ranking. Today, we rank in the top ten in Latin America and among the 150 best hospitals in the world, according to the latest data. 

We have achieved remarkable success and are proud to be affiliated with Johns Hopkins, a world-renowned hospital and university. Through various global partnerships, we exchange knowledge, professionals, and expertise, enabling us to accelerate progress in our field. Our commitment to technology is unwavering, ensuring we stay updated with the latest advancements worldwide. Our philosophy focuses on constantly adopting innovations within three years. And Moinhos de Vento doesn't want to be just a hospital – for the future, we want to be a healthcare company. So, the way forward is to invest in knowledge and people. 

EF: How do you envision the future of hospitals, and what role will you play in that? 

MP: Just as we witnessed technological marvels in movies during childhood, I firmly believe that reality often aligns with our imagination. These visions drive our investments and progress. As we look to the future, it's essential to embrace our dreams and explore scientific advancement to pave the way for cost-effective and impactful advances in healthcare. 

A shift towards a Lean perspective seems necessary for hospitals worldwide, including Brazil. While efficiency is crucial, improving quality and safety should not be overlooked. The future will likely witness a blend of Lean practices and increased technology adoption, especially in areas facing a shortage of healthcare professionals due to an aging population. Patients may turn to devices for self-analysis and diagnostics, while technology-driven solutions like remote surgeries with 5G or 6G support will enhance safety and accessibility. Embracing these changes can lead to a more advanced and efficient healthcare landscape. Technology is a tool – rather than an end. 

In the future, surgeries may be performed remotely. An attending physician will be in the OR and the surgeon could be in any other country. This is already a reality. So, we must be prepared for that. In my opinion, in the next ten years, there's hardly going to be any surgery without some sort of robotic automation at different levels. 

EF: What are the hospital's key initiatives regarding research and clinical trials? 

MP: Regarding future healthcare, ethical issues, improved technology, and cost implications are crucial considerations. The variation in healthcare spending among countries like the United States and Brazil raises questions about how objectives and targets impact outcomes, not just financial investment. Advancements in technology and medication, such as CAR-T cells and precision medicine, hold promise but also bring cost challenges. Tailoring treatments to an individual's genetics may prove more effective in the long run, potentially offsetting increased costs from cutting-edge discoveries. Striking a balance between medical progress and financial sustainability will be vital for the future of healthcare. 

Our strategic vision revolves around three pathways for the future hospital. The first one is education, with the establishment of a nursing school in 2018 and the imminent opening of a medical school, post-graduation courses, and a Ph.D. program. Over a thousand students are already enrolled in our ten post-graduation courses, drawing esteemed scientists and professors to our institution. 

Another pathway focuses on creating a Clinical Trial Lab and the Moinhos Research Institute. We are already among the top three in Brazil for clinical trials and have witnessed substantial growth in protocols, patients, and revenue. We aim to become five times larger than our current size in this area. In 2022, the Institute recorded important results, with almost 150 active trials. 

Lastly, we established the Atrium, an innovation hub designed to connect the Hospital with the healthcare industry and with startups to accelerate the culture of innovation. We are already connected with more than 400 startups across Brazil. We incubate, accelerate, and hire startups that bring innovative technologies to enhance efficiency, data management, and decision-making. This initiative aligns perfectly with our commitment to "We do what we say," emphasizing our dedication to quality and safety for our patients. 

EF: As you reflect on years of growth and rebuilding from the pandemic, what key milestones do you aspire to celebrate with your team as you approach the hospital's 100th anniversary? 

MS: One significant aspect close to our hearts is our history. As we approach our 100th anniversary, we plan to open a museum celebrating our community's journey. This initiative fills us with pride and exemplifies our commitment to fulfilling promises and shaping a brighter future. We aim to share our story with the world through this museum, welcoming the community and specialized press to experience our rich heritage. It marks just the beginning of our journey into the future. 

MP: We aim to elevate our hospital's global ranking and reach the top 50 within the next five years. Our goal for the next 10 years is to be the best hospital in the country. Currently, we are constructing a new building, which will be completed next year, and designing a 13-floor facility, whose erection will begin in 2024 with completion scheduled for our centennial celebration. This building will house our medical school, genetic lab, and first-in-human lab. Looking ahead to our 100th anniversary, we aim to generate nearly 50% of our revenue outside the hospital, transitioning into a fully digital hospital. Expanding our reach, we already have five units outside the main hospital. We plan to establish ten more, including a surgery center, to offer clean surgeries and diagnostics closer to people's homes. Ensuring financial strength is vital for our sustainability, allowing us to attract and retain talented professionals in Brazil and foster social justice through our endeavors. 

August 2023