Text: Regula Freuler | Photos: Markus Bertschi | Magazine: Customer focus – January 2019
Dr Wiesinger, you stepped down from your post as CEO of Hirslanden Group at the end of 2018. When you look back on your decade of service at Hirslanden, what are you most proud of?
We managed to bundle a rather loose network of hospitals into a serious medical enterprise and brought systematic methodologies to the company through collective thinking. This also includes regular, uniform quality metrics for all hospitals in the Group. Only this way was it possible for us to gain equal footing with the competition.
Hirslanden Group has grown enormously during your time in office.
That’s correct. But for us, it was never merely about growth for growth’s sake. I don’t have a better standing just because we now have 18 clinics instead of 13 and our revenues today total almost CHF 1.8 billion instead of 1 billion. The idea was and still is that every patient in each location, at least along the west-east axis in Switzerland, has the opportunity to enter the Hirslanden world, be it a doctor’s office, a medical practice complex, an outpatient OP centre, a regional hospital, a specialised hospital or a maximum care facility such as the Hirslanden Clinic or the St. Anna Clinic. We’ve gotten to where we wanted to be – except for Basel-Stadt. We haven’t managed that yet.
“It’s like the referee is playing with the opposing team.”
What was the greatest difficulty in this transformation process?
The Swiss hospital sector is not a free market, and that’s a problem. The 2012 Health Insurance Act revision, which we supported, had the goal of stimulating competition – but exactly the opposite happened. The cantons have too many hats on. To use a metaphor from football: it’s like the referee is playing with the opposite team, or – even worse – he’s our goalie.
And the consequences?
The cantons are the largest hospital operators in the country. They also set the tariffs and determine who can “play” and under what conditions. They regulate highly specialised medicine, and if things go as I fear they will, they’ll be able to regulate even more in the outpatient area going forward.
Two parliamentary initiatives are pending in the Cantonal Council of Zurich which would set a mandatory minimum on the proportion of basic-cover-insured patients that accredited hospitals must provide care for. The thrust is aimed at clinics such as Hirslanden that have a high percentage of patients covered by supplementary insurance. What’s the next step in this matter?
The factually correct comment here is: we treat 100 per cent of the patients with basic insurance, because every patient with supplementary insurance also has basic cover. This actually should put the discussion off the table – but it doesn’t. Naturally, some people like to accuse Hirslanden of having focused for years on being the number one choice for patients with supplementary insurance. But any public hospital could have done this all the while! And what many don’t know or others don’t want to believe: go wherever you wish to within the Hirslanden Group and you’ll see that around 50 per cent of our patients are covered only by basic health insurance; at some locations, that number is almost 80 per cent.
Born in Hamburg in 1962, Ole Wiesinger knew early on that he wanted to “open up people’s belly”. In 1980, he started his studies in biology and chemistry, followed by medicine. He also trained as a paramedic and emergency room physician. On top of that comes a degree in health economics with specialisation in diagnosis-related group systems. In 2004, Ole Wiesinger became Clinic Director of Hirslanden Zurich. From October 2008 until the end of 2018, he was CEO of the Hirslanden Private Hospital Group and member of the Executive Management team of Mediclinic International.
For a number of years now, the cantons have been committed to the principle of “outpatient before inpatient”. How much pressure does this put on Hirslanden Group?
That doesn’t just put considerable pressure on us, but on the entire healthcare system. In principle, this trend is on the right track. A large proportion of surgical procedures and other medical interventions as well can be performed on an outpatient basis. This is the cheaper and faster way, and it’s not significantly worse in terms of patient comfort.
It sounds a bit “drive-through”, though.
Agreed, but patients usually like that. After all, who wants to spend time in a hospital? The question is simply one of how to introduce “outpatient before inpatient”, at what speed and at the risk of which consequences.
Is the system infrastructurally prepared for this?
No, there are too few functioning outpatient surgery centres. But that’s only one aspect. Another one is: at what tariff can you offer this? According to the existing Tarmed tariff schedule, outpatient surgery is poorly remunerated. Patients who would otherwise be treated in the expensive inpatient infrastructure will more and more have their operations conducted on an outpatient basis, but with expensive personnel, expensive processes, expensive material, and all this at a rate that doesn’t really cover costs. This has already left enormous skid marks on the system – and at all hospitals in Switzerland.
You once said that Hirslanden doesn’t view their patients as “customers”, but rather as “guests” – why that?
Even the term “customer” is a step in the right direction, because the terminology used previously in hospitals sounded like it came from the penal system: admission, dismissal, transfer. The “patient” is the sufferer, and for many decades this term was considered an appropriate description in the healthcare system. Nevertheless, the change of perspective from “patient” to “customer” is at least correct: hospitals are service providers, simply with another kind of relationship with the customer. In a certain sense, medical care is made to measure – because every patient is individual.
So what’s then the difference to “guest”?
We shouldn’t kid ourselves: we’re selling a service that nobody really wants. Who goes to a hospital willingly, where it’s about illness, pain, fever, medication. That’s why a differentiated understanding of what most people would call a “customer” is so important to us.
You yourself practiced as a doctor for quite a long time. How close are you to the patient these days?
Unfortunately, not as close as I used to be. But especially from my emergency medical care experience, I was able to learn a lot about management. There are many parallels: you’re always in the limelight, teamwork is indispensable, you have to make decisions and live with the consequences. Communication skills are just as important. And, perhaps most of all, you have to be able to deal with stress. All things considered, there’s nothing that I’ve ever done more gladly than work in the emergency room. But I don’t regret my later career. Everything has its time in life.
Where does Hirslanden have room for improvement?
The interface between the clinic and the physicians who treat patients after their hospital stay; in other words: exit management. But we’re working on this and are continuously interviewing all our patients – for the past two years, even on an international scale.
How have the demands of patients changed over the past decade?
What’s really changed is their level of knowledge. They sometimes come to the doctor and, in questionable cases, know more about what they suspect is the tentative diagnosis than their doctor does – which can really put him in an awkward situation.
Are there also advantages to this heightened patient knowledge?
Certainly. The knowledge asymmetry between doctor and patient used to be huge. The doctor could attempt to level things out by acting empathetically – or not even go there by simply coming across as “God in white”. However, the doctor-patient relationship suffered as a result. This kind of condescension is less pronounced today. There are probably doctors who don’t like the fact, but if you want to discuss things on a par with patients, it’s an advantage if they already know something.
The Hirslanden Group operates 18 clinics with 1,800 beds in 11 cantons and has an annual turnover of CHF 1.735 billion. The private clinic group, which now employs some 9,600 people, was formed in 1990 as a result of the merger of several private hospitals and since 2007 has been part of the international hospital group Mediclinic International plc, which is listed on the London Stock Exchange. The 18 Hirslanden clinics generate almost half of Mediclinic’s annual turnover. Its remaining 58 hospitals with 9,000 beds are located in South Africa, Namibia and the United Arab Emirates. Daniel Liedtke took over as CEO of the Hirslanden Group as of 1 January 2019.
Costs are the big issue in healthcare these days. Where can savings be achieved?
In the Swiss healthcare system, it would be possible to reduce costs without really losing anything. But this requires a socially and politically initiated discourse on what solidarity-based financing means. Our healthcare plans work like comprehensive collision coverage on your car. At the moment, this can be half-decently financed – but for how long?
What do you propose?
There should be a catalogue of basic services financed collectively. Anything that is not included, should be privately insured in a modular fashion. This may not yet be capable of gaining majority backing, but it’s a realistic scenario for the future.
The discussion about costs always boils down to the expensive measures taken late in a person’s life. What are your personal thoughts on this?
I don’t really prefer to skate on this thin ice. But I actually believe that the issue finally needs to be settled by the general populace. For the time being, everyone has to figure it out for themselves. I don’t think highly of the discussion about putting a price tag on years of life. That would be a mistake. But we need to face up to the issue. In 30 or 40 years, life expectancy will be over 90. We’ll be surrounded by centenarians who are still relatively fit and, of course, entitled to appropriate medical care; for example, receiving a new kidney if theirs fails.
Ethically, a sticky wicket indeed. How should this discussion be kick-started?
One thing’s clear: any politician who dares even a whisper about the subject today is out of a job tomorrow. So somehow it needs a social effort, a kind of crowd-backing effect. I don’t know when that might come about. The simple fact is that presently, there’s still a lot of money in the system and the degree of suffering is therefore comparatively low.
But the public seems ready to start a discussion when it comes to the astronomic prices for drugs that treat rare diseases.
Right. That’s the iceberg syndrome kicking in: something sticks out that’s quite obvious; forget about what’s below the surface. Everyone thinks: “OMG – so many thousands of francs for a hepatitis C medication!” But at least it takes the discussion in the right direction.
If fundamental research were to be allowed at Hirslanden Group, in which field should it be?
In principle, fundamental research is the bailiwick of the universities. Personally, I’m firmly convinced that one day we’ll get cancer under control. My other great hope is that we’ll no longer be dependent on organ donations, but instead that organs can be made from stem cells. It’s doable, so let’s do it.
Brief questions – short answers
Your personal goal for 2019?
A wise man once told me: “As a young person, you wonder what life has to offer you. As an aging person, you turn the whole thing around and ask yourself what you still have to offer in life.” I’d like to find an answer to that question in 2019.
The most important advice you’ve ever received?
Less a piece of advice than an important tip, namely that there’s such a thing as “systemic parenting”. It means that I have a similar responsibility for my employees as a father has for his children. This gives rise to pivotal questions: how do I lead people? How do I relate to my team? What is my role as a boss?
Cinema or museum?
The movies. After a strenuous workweek, I just want to sit back and let myself be swept away. But in quieter times, I also like to go to the museum.
Novel or non-fiction?
Novel – due to the fact that I have to read so many professional journals. That may change in the next several months, though.
Some advice that you’re happy to pass on to others?
To young people, including my children, I always say: “Get the work done, then you’ll have success.” I believe in human qualities such as stamina, perseverance, consistency, determination. You’ll always be successful with that.