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Chairman and CEO of USP Europe
  Gabriel Masfurroll Lacambra
Gabriel Masfurroll Lacambra
Chairman and CEO of USP Europe

Tell us about USP. How did the company start?

I started with the help of a group of collaborators. We had been pondering this project for a long time. We got deeply into debt, we mortgaged all our properties, and we finally took the plunge, as they say. The result has been very positive, and I am sure that the success is due to a number of things, most of all, of course, the hard work of a lot of people, although I suppose that we have also been very lucky. An American expression sums it up well: "We were the right people, in the right place, at the right time". One of the key factors was having learned from previous mistakes. Ten years ago, during a month-long business trip, I showed my business plan to a lot of investors, in an effort to find financing in the U.S. But it was not the right time. The U.S. was going through a severe economic recession, but that fact, later on, helped us choose the best moment. Now we are extremely satisfied; our growth is significant. When we look back, we remember the way we started: only five years ago, just three of us in a small office in Madrid. Nowadays there are more than 1,500 professionals working for the company, hospitals in six Spanish towns, 1,300 doctors, a total of 17 medical centers, and the company invoices more than 100 million euros. Our rapid growth, the uniqueness of the project, and the effectiveness of the hospitals have given us a certain prestige, although we realize we are only halfway there.

What is USP? What is the company's mission and what are the keys to its success?

The answer is obvious: USP is a very well planned company. The key is that for six years before starting the company, we worked hard, studied, and thought out the project which allowed us to be sure where we wanted to go and how. Another key factor, although it may sound like a cliché, is our staff: bright and talented but, above all, very good people. Of course, it was also very important to have partners in the U.S. who not only give us the freedom to act, but moreover believe in us and trust us. In other words, there is no colonialism. It's from them that we have learned how to act in our hospitals. What I mean is when we buy a hospital in Seville, for example, we like it to be run by people from Seville; the same goes for Galicia, Catalonia, or for any other region.

Is USP an international company that adapts itself to the local markets or do you have a central strategy and policy? What happens when you purchase a medical center? Do you keep the staff on?

It depends. We make tailor-made suits. I learned that from my grandmother who was a seamstress. What I mean is that in Spain each of the local markets has its own rules in spite of the fact that it is not a very big country. We adapt our offer to what the market demands. Sometimes we purchase hospitals that are very well integrated into their community. For example, the person who is managing our hospitals in Andalusia - one in Seville and another, which we have just bought, in Marbella - was one of the previous owners and the general director of the Seville hospital. When we bought it we asked him to stay on and he said he would but for not more than two years. Well, not only did he stay and manage the hospital, he has now been working for us for four years and has reinvested part of his money in a block of shares the company has recently tendered.

In other centers that we have acquired we have, for various reasons, had to appoint a manager, such us that they were the property of physicians or a religious order and they had neither the ability nor the desire to continue running the hospital.

There have been a few amusing anecdotes. For example when we opened a new wing of the hospital in Murcia which had been acquired from a religious order, the nuns were there, as if the hospital were still theirs. They were thrilled. It is all part of the job.

What are USP's objectives?

One of our main objectives is to become part of the community, that is, to serve the citizens. Our motto is: "Our service is a feeling". And it is not easy, because it is easy to just stereotype client service, quality, all those things we are always going on about, but what is clear is that our industry deals with sensitive issues. When a person sets foot in our hospital, in addition to being physically ill, he has a psychological handicap as well. Disease itself produces fragility; there is a loss of self. Our obligation is not only to help a patient recover, but also to return him to a positive outlook, so that he can leave the hospital globally healthy. This is everyone's job. That is, the health professionals reestablish the patient's health but the entire hospital staff must also take part. How do we do it? We try to make the rooms look as similar as possible to their own environment: happy and full of life. Hospitals in the past were so gloomy. We hang pictures on the walls; we try to make people smile. There are a lot of small details, but this is everyone's daily task.

As I said before, we are a young company, five years old, continuously buying hospitals, one after another. These hospitals require an enormous amount of work, a huge effort on everybody's part: from those of us taking the hospitals over, from the people we put in charge of them, and from those who will be working for us. This is a big change for them too, and we have to understand that together we must focus our attention on each client who decides to put his health in our hands. It is an exciting job, and I would even dare to say a tough one.

Please, compare the U.S. and Spanish healthcare systems.

I think there is no way to compare the two. They are two radically different models. In Spain the National Public Health Service covers virtually 100% of the population. The problem is, like everything in life, the National Public Health Service can only do so much. The population is aging rapidly. Life expectancy, even if it does not increase, remains constant and it is very high, among the highest in the world. There is a very high rate of immigration due to the improved economy in recent years. What I mean is that the demand for health care is growing practically exponentially, while the provision is not. In Spain many, many years ago and forgotten by many, there was a dichotomy, public health / private medical care; it was almost like a standoff. I would say that private medical care was considered to be the personification of evil and that money should not be made from health. This idea is becoming something of the past, and what is very sensibly being done is to make all resources available to the people, regardless of legal ownership. They are available based on the quality and services they offer.

It is true that, just like in the U.S., there is a certain percentage of the population, between 18 and 20%, that feels that public health does not provide the satisfaction they expect and take out additional health insurance policies that cover private hospital services. We are talking around 8 million people in Spain who, in one way or another, use private medicine. But it is also true that more and more of the public sector uses private hospitals to meet the growing demand. Therefore it is a kind of mixed system.

Something similar is happening in the United Kingdom as well. In the U.K., which has a system similar to the Spanish one - the National Health Service - there is also a system of private hospitals. That is to say, the demand is so great that all resources have to be made available to the citizens. Maybe we will reach a point, I don't know if the time is right yet, when there will be a guide like there is for other things. That is, the person would have a guide that would allow him or her to choose, qualitatively, what his or her medical care should be. Today, if you want to choose a restaurant, you know which one has 3 Michelin or CEPSA stars, or which hotels have 5 stars. Interestingly enough, this does not happen in hospitals. With regard to our most precious possession, our health, where should we go? God knows… but this too will come, for now we are taking it step by step.

Could these be the reasons for the creation of USP?

USP started for a very simple and obvious reason. That is, in Spain there are more than 400 private hospitals but there was no chain of hospitals. It was an extremely fragmented field. At best there was a little chain of three or four hospitals but nothing substantial. That was our "eureka" moment: a chain of hospitals, with good brand recognition, with synergy, and good lines of communication. Just this morning we were interviewing a woman who said: "I did not know you had a hospital in Vitoria. Of course, you are all over! I was looking for a pediatrician for my daughter who lives in Vitoria and I am a client of Dexeus, so I go to Vitoria, start looking and say to myself, 'Why, they are the same ones as in Barcelona!'" This is what we want, people who travel, whether you live in Barcelona or in Madrid or in Zaragoza, wherever, you'll find a USP hospital there.

You have your medical history and if you move, if you go to work somewhere else, or take a trip and have an accident, you know that the hospital that is a member of the chain will be in contact. There will be doctors talking to doctors and everything can be taken care of much more easily. As a result, your sensation of emotional welcome will be much better than if you went to a hospital and thought, "Who is going to treat me and take care of me?"

This is the concept: to create a homogeneous chain on a general basis. It is not easy but we are working hard on it, and we are heading in the right direction.

How do you create a homogeneous brand, given that many of these centers already existed, had their own image, and keep on many of their professionals?

We do it by creating standardized product lines. Let me give you an example. We have created one that we call "sports medicine". We are fortunate to have prestigious medical professionals in the field of traumatology and sports medicine in our hospitals. This is all very good but where do you go with that? How can you sell it? This is not Wal-Mart; it is not easy to sell it. We must be creative and find formulas. We are trying to ally ourselves with sport clubs. For example, Donato, a player for "el Deportivo de la Coruña", one of the most outstanding soccer teams in Spain, was injured. Although he is not a young player and is about to retire, he is a good one, but the injury, due to his age, was not a simple one to cure. Our doctor in La Coruña, who treats all the players on "el Deportivo de la Coruña", said, "Mikel Sanchez in Vitoria has a very good special technique. He regenerates tissue that accelerates recovery". Rafa Arriaza, the Coruña traumatologist, accompanied the player to Vitoria where he was treated and now he has fully recovered. This sells, because you know what soccer is in this country. It has a great impact on the media and therefore causes imitation. That is how we create our brand image.

Another example: I think that a well-spoken person can sell snake oil, but what is important is to sell examples. God willing, in a few months, we are going to inaugurate a women's health center in Murcia, sponsored by Dexeus Institute. The Dexeus Institute of the University of Barcelona has made its name, most notably, in OBGYN (obstetrics and gynecology) and human reproduction. The Dexeus Institute is opening this Women's Health Center that will treat all female pathologies. This is another line.

Another example is the design of a business line called "Hospitur", a combination of the words hospital and tourism. Spain receives 50 million travelers and tourists a year, more than the total population of the country. Of these 50 million, some get sick - they do not get malaria, but they do have problems. Our hospitals are located in places that attract a high volume of business travelers and tourists. Barcelona, Madrid, Seville, and Marbella are popular cities. We have reached agreements with the most important tour operators in the country and we have a network to serve. Many agencies inform their clients of our services in case they travel to Spain, to a particular area, and want a reliable hospital. This is another business line we have. It is not easy. Remember that acquired hospitals that had their own character, be it religious, medical, inherited and passed from hand to hand etc, each made its own rules. What we are trying to do is to organize these services based on what the market demands and then try to get them into sync and connect them.

What is the common denominator of all these centers? That connection that you mention, does it include transferring professionals within the centers of the group?

The management systems are very similar. What happens is that they are flexible and adapted to each market. The management systems are not different, but we understand that there has to be a certain amount of give and take and we must adapt to each market. As to mobility, some physicians do go from one hospital to another, and there are some in different hospitals that do things in collaboration.

RDI, still "unfinished business" in Spain, is a key factor for successful businesses to lead the increasingly global and competitive markets. Where does USP stand?

Let's see. I would say one shouldn't sell smoke and mirrors, and therefore, our hospitals are what they are. Research and development projects can be either serious or not. Actually we do little research and development but the little we do is of high quality. The Dexeus University Hospital Institute, one of the few university hospitals in Spain, has pioneered the field of human reproduction. We are leaders, and this is the result of the research and investigation process.

In Vitoria, Doctor Sanchez and his team are leading Spain with their regeneration and tissue growth project. In fact, foreign doctors come to learn how it is being done.

We have a few things but within our possibilities. We must not forget we are still a medium-sized business. But we know that if we want to keep on growing we have to investigate to the extent that we are able.

Is the research carried out internally or do you collaborate with other national or international centers?

We are cooperating, even collaborating, with other universities where joint projects, be they regional, national, or testing done with other countries, are carried out. In fact we have relationships with North American universities. For example, in Coruña, Professor Juan Alvarez, who came to Spain two years ago from Harvard, directs our human reproduction service. He has continued collaborating with Harvard University and they are working together. There are many examples. In fact, I would say that Spanish medicine has nothing to envy regarding North America.

The fact of the matter is that the U.S. is very rich and has spent enormous amounts of money on its hospitals; its medical cathedrals, as I call them. But here in Spain, we have very good physicians. I could mention dozens - I do not because I know I may leave someone out - who are world class and work in Spain, and some of them have been trained here.

You said that Spanish healthcare services are equal to, if not better than, those of North America. However, its professionals are not held in the same regard. In Spain they are seen as civil servants. Are North American doctors overvalued or are Spanish physicians undervalued?

When we deal with physicians, we try to make doctors aware of business issues. That is, Spanish doctors have evolved from being almost God-like, with only a few extremely important nationally recognized figures who were leaders in the society we lived in, to being overcrowded. There is such a huge supply of physicians that they have become civil servants. What we aim for is something more. We know that there comes a time in life when one progresses, matures, evolves, and wants to improve. I am an executive, but there comes a time when I want to be an entrepreneur, make my own decisions, and take my own risks. Doctors do the same. We try to make them into businessmen. We help them become businessmen. We make collaboration agreements between the hospital business company and physician businessmen, and we make strategic alliances. In some cases these are already established and we invest jointly. This is one of our company's greatest strengths: strategic alliances that we form with physicians. This allows us to incorporate prestigious physicians; physicians that have grown tired of public hospitals where they are not taken into account, and who have initiative that they can develop with us. This is one of our great advantages. In fact, this is readily demonstrable. If we could compare the physicians there were when we started with those we have now, we would see that the volume has increased, not only in number but also in prestige. In no way does this suggest that those we had were bad. We have been very fortunate to have purchased hospitals with magnificent professionals, but we have also attracted new ones and this creates a very interesting competition.

How are new technologies in the healthcare industry changing the way you work?

This is basic. I believe technology is fundamental. For example, in some cases in our laboratories, we are already sending results via e-mail. Now we are trying to do the same with image technology, that is, send X-ray images by cable. This even allows us to optimize resources. We have three hospitals in Madrid with image diagnosis services. Each one has people working there. You can create a pool of excellence where people receive the images and interpret them, whilst in the hospitals the only thing that needs to be done is the procedure and nothing else.

The future could be in on-line hospitals, in the widest sense of the word. We have already seen developments like telesurgery, nanotechnology, etc…

Consultations, yes. This is already being done, but it does not go any further. A hospital requires touch, physical contact, and the Internet is only virtual. I do not know if it is because I am incapable of imagining the future but I do not think it is possible. I have seen interesting projects, videoconferences where you can see the patient, but it is not the same.

A neurosurgeon friend of mine did remote surgery from his sailboat in the Mediterranean, here in Spain. I was with him; I saw it. This is done in Spain and not in other advanced countries. It is a reality.

Getting back to USP, what is the key factor in USP's success?

I still think that the human factor is very important. Every six months we do surveys. The standard questionnaires, for me personally, are not valid. I call them "Stockholm Syndrome surveys". Bear in mind that the patient is in the hospital when he does the survey and says, "I am going to praise everything because they still have not released me, or because I might have to come back". In our surveys, which can last up to an hour, we ask them about everything: how they have been treated, how the admitting process went, about the medical attention, the nurses' attention, the cleanliness of the hospital, the room…. The main objective is to improve. It is all well and good that they say we are fantastic, that we do a good job, but we like to know where we fall short in order to improve.

Yes, surveys are fine, but what is your ability to react and how important is the compiled information?

We are quite fast, but we like to do things fairly. That is, if a given nurse or doctor is criticized, it is not significant for us. Now, if there are a series of complaints what we do is find out what is actually happening. Many things can happen: that the person involved is going through a bad period, that he/she is dissatisfied, etc. We evaluate the causes before making a decision. We try to be fair. We think that in order for patients to be well cared for, the staff that deals with them has to be satisfied. If not the patient suffers. What we do not accept is incompetence.

Are you going to expand? Are you going to go to other countries?

We have had a natural evolution. That is, when we started, we needed a certain critical mass to grow and were less rigorous about our acquisitions. In no way does this mean that those we acquired in the past were bad. Yet today we are stricter and we demand more from each acquisition.

What do I think of USP's future? I would say that in Spain we are halfway there, we are half the size this company should be. We are trying to approach a country like Portugal and we might approach some other Southern European country. If Spain is a country with an astonishing array of markets, imagine what Europe could be like. We are talking about Europe, where Germany has nothing in common with Belgium, Belgium has nothing in common with France, and France has nothing in common with Portugal. So, we would like to approach countries with customs similar to our own.

In any case, what we are never going to do is dabble. That is, buy hospitals in Germany one day, and in Belgium the next. When we invest in a country we do so to stay there for good. That is what we are doing in Portugal. Firstly we make acquisitions, we settle in, we become familiar, and we progress. And if we progress, then we look at the possibilities of building. In Spain, up to now, we have not built anything, but I think that in a week's time - I say I think because we have licenses pending - we are going to start building a new hospital in Barcelona.

You have been telling us about the homogeneity of USP. How do you manage to change the image of the acquired centers? How do you transmit your core values if most of the professionals stay on?

You can change the image in many ways. First, the acquisition by and of itself is an important change. Taking advantage of this momentum and attention, not only of the media, but also of the community, you create the image. Secondly, once you have made the acquisition, you must invest and improve the facilities; if the hospital is not in good shape, you must make repairs. This alone increases the market's perception that the hospital is changing. You have to work with the staff, giving them a new vision of client care, and then you must work on day-to-day issues, on the corporate image, and on the media.

And what about the staff? Are the people who work in the centers also projecting the company image?

Yes, take a look at Madrid. We have bought a hospital there and what we want is that each time we hire somebody, they stay on until the last day. But, as in any other company, there are people who fit in and people who do not. There are people who do not fit into the organization and there are people who do not like it. This is a fact of life. Nevertheless, the degree of integration into the company is very high.

What are USP's values?

I would say rigor, professionalism, humaneness - which is a word that I do not like much but it is hard to find another - and accessibility.

In closing, what would you say to readers of the New York Digital about Spain?

I would say Spain is a wonderful place to live, in every sense of the word. It is a calm, pleasant, comfortable, technologically very advanced country - much more than people think - with an excellent healthcare system. USP is a part of the country's excellent system and is trying to be an industry leader in Spain and in other countries as well.

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