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‘Getting my hands dirty’

Innovation & Sustainability

15 January 2020

Orthopaedic surgeon Ivo Buchholz also serves as Chief Medical Officer of NPM portfolio company Bergman Clinics. The combination of performing surgeries, daily interaction with patients, being an active part of the policymaking process and being involved on the commercial end of things means no day on the job is ever the same for him. We asked Dr Buchholz to describe the “best job in the world” in 10 keywords.

1. Business
“I started out as a physiotherapist and only qualified as an orthopaedic surgeon later on. I cut my teeth at a regular hospital, where I was soon appointed to a management position in addition to my medical work. During my tenure as a manager, I turned orthopaedics into a separate department, away from the rest of the hospital, as I was looking to change the organisational model. Even back then, I realised that when independent clinics can act more swiftly within the hospital, they can also attract more committed employees and improve team spirit. The work I do currently is basically a continuation of that, except on a much larger scale.”

2. Specialised clinics
“The methods and techniques we use in our medical treatments here are essentially not all that different from those used in hospitals. One difference, however, is that our organisational model is fundamentally different. We make clear choices – solely elective procedures in a number of common problem areas – and ensure quality through our more narrow focus and the large number of treatments. Our patients present to us for one specific procedure, and everything is tailored to that particular procedure. This creates possibilities which are simply not available in existing hospital models: a far more efficient process, short waiting lists and friendly and personal service.”

“Our patients present to us for one specific procedure, and everything is tailored to that particular procedure”

3. Specialisation
“All medical specialists focus exclusively on a specific sub-area – that is literally all they do. I personally perform only knee and hip surgery. You might think of it, somewhat irreverently, as a particular ‘assembly line’ in a factory, except I don’t actually think of my job as being anything like factory work at all. The advantage of being restricted to that one area is that you can continue to specialise and receive the training you need to reach the top of your field. It is really because you’re aware of the finer points of that particular type of surgery that you can continue to hone your technique, and there’s something very gratifying to me about that. Your average orthopaedic surgeon working at a hospital might perform between 20 and 30 hip surgeries a year, whereas our specialists do between 200 and 300 a year.”

4. Innovation
“What makes our model innovative is essentially the organisational model itself. We offer a self-reinforcing loop of learning and improving in terms of quality and efficiency. This applies to the medical treatment itself, as well as to interaction with patients and cost structure. Embracing medical innovations is also easier in our model, because if a supplier has a new type of prosthetic or an alternative technique on offer, they will be more interested in doing business with a clinic that performs certain types of surgery several thousands of times a year than a hospital that carries out the same type of operation only a few times a year. In other words: high volumes make it possible to test and implement innovations more quickly. So the likelihood that we’ll make some changes on the medical end, doing them differently from regular hospitals, is certainly there.”

5. PhD students
“Specialised clinics such as ours remained somewhat on the margins of the Dutch healthcare system for a long time. They tended to employ specialists who were fed up with all the red tape in hospitals, and simply wanted to do their jobs. We are now taken seriously, and medical residents and assistant surgeons tend to prefer working for a specialised clinic over a regular or university hospital. We are particularly interested in hiring high potentials who want to learn from the finest specialists. While there will, of course, always be idealists who want to do scientific research at a university hospital, I think that specialised clinics will become more appealing in the coming years to PhD students who are interested in improving standard procedures based on the large amounts of data we collect here.”

6. Medical expenses
“Before specialised clinics became established in the Netherlands, the cost of hip replacement surgery was around 10,000 or 11,000 euros. The price of the procedure has since fallen to 8,000 euros, simply because providers like us focus on cost-efficiency. This is not necessarily good news for regular hospitals, as they used the revenues generated from these types of common procedures to cover part of their real estate costs, which tend to be sky-high. Since these funds are declining, some hospitals have run into trouble. Many hospitals have basically become real estate management companies whose sole responsibility is to keep the hospital as full as possible in order to cover their property-related expenses, which prevents them from making any real strategic decisions. There is also the fact that the costs of acute care and oncology keep increasing, as well as those of care for the chronically ill to an extent. So many hospitals are in a tight spot financially, which means they are paying closer attention to how we organise our operations.”

7. Practice
“I spend a total of what amounts to two days a week in management as a CMO – I wouldn’t want to miss it for anything. That being said, I do also want to get my hands dirty, so to speak, so that I’m reminded every day of what it means to work with patients and interact with the back office and the assistant surgeons. If I gave that up completely, I would turn into a full-time manager, and that’s when the other specialists will eventually stop accepting me as CMO. You really need to keep one foot in the world of practice – apart from the fact that it’s a lot of fun. That’s what makes this the best job in the world for me.”

8. Patients
“Patients are changing in that they no longer automatically choose to seek treatment at a local hospital. They are increasingly willing to travel if they know they’re going to get higher-quality care, shorter waitlists and a more personal approach. This means we can cover an entire region with just a small number of clinics. For example, we centralised our plastic surgery division in Hilversum last year: all specialists in the Netherlands perform their surgeries there. It really helps that we have organised all the related facilities so well.”

9. Hospitals
“Why did hospitals become hospitals at some point along the way? Mainly because it made sense for the various medical disciplines to share a number of facilities, such as operating theatres, beds and logistics support. The problem is that hospital management ends up growing into this behemoth, creating highly complex, sluggish organisations. We’re essentially going back to basics: small, flexible organisations with a maximum of 50 beds and four operating theatres. It means you can be client-oriented and work efficiently, without any of the attendant ‘policy creep.’”

10. Cooperation
“We are certainly not opposed to public hospitals: ideally, there would be some sort of alliance, where we would be able to collaborate in certain areas. And sometimes we simply need hospitals and their resources, like when we need to lease specialised equipment such as bone-scanning devices. Fortunately, we have been noticing a growing mutual respect in recent years, with both sides accepting that there is room enough for all of us and that we can peacefully co-exist. This will ultimately be more beneficial for everyone than mutual hostility.”

Read more about ‘Tech for people’ in Capital Magazine