Asier Agote: “An intermutual hospital is synonymous with efficiency, quality and commitment to workers”

He Euskadi Intermutual Hospital is a reference center in healthcare for injured workers, offering specialized and high-quality assistance. For more than 15 years, its managing director, Asier Agote, leads hospital management with a focus on efficiency, innovation and care excellence. Graduated in Business Administration and Management, he has a solid track record in healthcare management, having held different roles in the hospital before assuming management in 2008. In addition, he has complemented his training with senior management programs at institutions such as IESE and the Carlos III Health Institute.

In this interview, Asier Agote offers us an up-close view of the present and future of the Intermutual Hospital of Euskadi. We talked about the challenges of managing an intermutual facility, the importance of resource optimization, and how the hospital continues to evolve to ensure the best possible care for protected workers.

What is the origin and main motivation that led to the creation of this center?

Before the Intermutual Hospital of Euskadi (HIE) was established, this facility was attached to the mutual Mupag-Previsión (finally integrated into Fraternidad-Muprespa), with very little activity, poor facilities and, consequently, presenting continuous deficits in its management.

Within the framework of actions promoted by the Administration, in order to obtain greater and better use of the hospital centers managed by the then Accident Mutual Funds, and with the intention of having their own quality resource that did not depend on third parties, in 1995 the current Collaborating Mutual Funds with Social Security Fraternidad-Muprespa, Fremap, Asepeyo, MC Mutual and Mutua Universal formed an association, under the protection of the then General Directorate of Legal Organization of Social Security, which gave rise to the renovated Intermutual Hospital of Euskadi, inaugurating it in October 1996.

Managing a hospital that cares for patients from different insurance companies can be complex. What are the challenges that arise when managing a hospital with patients from five mutual insurance companies? How is this reality addressed in practice on a day-to-day basis?

Indeed, the origin of our patients is diverse. We serve accident victims from five different mutual insurance companies and, in turn, from very different geographical origins, with different internal procedures even within the same mutual insurance company. Currently, our area of ​​influence reaches the Basque Country and its neighboring provinces; specifically, Vizcaya, Guipúzcoa, Álava, Navarra, Cantabria, La Rioja, Burgos and even, in some cases, Asturias.

Taking this circumstance into account, our objective is to comply with the expectations and procedures established in each of the mutual societies, in each of the delegations and, I would dare say, for each of the files.

Obviously this objective is not easy to achieve and to achieve this we work in two aspects: on the one hand, we promote commissions (administrative and medical) in which, together with the Hospital management, those responsible for each participating mutual fund participate, in which we try to agree on procedures and avoid or minimize the number of exceptions. On the other hand, we maintain a very fluid relationship and communication with the administrative and medical directorates of all the participating mutual societies and in the same way, internally we process and communicate the instructions of the mutual societies.

Consequently, the Hospital staff works applying common procedures for all mutual insurance companies and with few exceptions that, in any case, are channeled through the medical directorates.

What is the contribution of Intermutual Hospital to the Social Security system, especially in terms of optimization of health resources? How does it fit into the strategy of maximizing efficiency in a system with limited resources?

Efficiency and optimization of resources is what gives meaning to an Intermutual Hospital. It is a non-profit hospital center in which the participating mutual societies share expenses and to which they refer patients who require this specialized care, reaching, in our case, historical maximums of activity, which contributes to meeting these objectives.

Furthermore, I consider that from the perspective of efficiency and optimization of public resources, the figure of the intermutual hospital should be reproduced in other locations; more, if possible, with the existing shortage of health professionals. Currently there are only two intermutual hospitals: Levante and Euskadi.

However, the paradox arises that, given the limitations that we suffer in the sector, and despite being a resource specific to the Social Security system, sometimes the shortage of personnel and, consequently, the reduction in the assistance offer that we could present, causes the activity to end up being diverted to the private sector, contrary to the guidelines of the General Directorate of Social Security Regulation, our management and supervisory body.

What are the main objectives in terms of quality of care?

Regarding the Hospital's objectives, we must always keep in mind the recovery of our patients to return to their jobs in the best possible conditions and without incurring unnecessary delays or waiting times.

In line with what was previously mentioned, the Hospital's main objectives are: achieve 100% compliance with the surgical check-list that guarantees patient safety; not to exceed three days on average in the appointment of first consultations (five if they are patients from other provinces in which we try to ensure that, for some pathologies, in the same trip the patients are seen in consultation, admitted and the next day have surgery); do not exceed ten days on average in the surgical schedule; and achieve an average rating of the Hospital by our admitted patients of at least 9 points.

In addition to the aforementioned objectives, in the healthcare field the percentage of readmissions, reinterventions and infections is also measured.

This hospital is a reference center in traumatology. What role does it play in the field of research and teaching for better clinical practice? 

This is a hospital in which its doctors, led by the Medical Directorate, stand out for their research and teaching profile. So much so that some of the additions to the trauma team began their relationship with our Hospital as residents of other hospitals who, attracted by our volume of surgical activity and the techniques applied, collaborate with us to present scientific publications.

Although it is true that sometimes day-to-day life and the difficulties in incorporating specialized medical personnel cause us to have to focus on care activity, in this section I would highlight our Pain Unit, which has been a pioneer at the state level in the application of the "Intracanal bipolar pulsed radiofrequency" technique, as well as our Wrist and Hand Unit, in which one of its members, Dr. Christian Rodríguez, has obtained the European Diploma in Hand Surgery awarded by the FESSH (European Federation of Hand Surgery Societies), which has allowed the HIE to become a hospital with European accreditation for wrist and hand surgical training. Currently, in Spain only eight people and, consequently, eight hospitals, have this distinction.

In the same sense, more and more trauma residents from other hospitals want to come and rotate with us, and it is also worth highlighting the accreditation of our Hospital as a collaborating center with the University of Deusto, among others, so that students of the degrees in Medicine, Nursing and Physiotherapy can carry out their internships in our facilities.

How is the center financed?

The Participating Mutual Funds (Fraternidad-Muprespa, Fremap, Asepeyo, MC Mutual and Mutua Universal) finance the Hospital's annual budget, including budget modifications that may be authorized throughout the year. Each mutual fund is assigned a financing and consumption commitment percentage that is calculated based on the average consumption of the last three years.

However, on a quarterly basis all these contributions are regularized to the actual consumption of each mutual insurance company (except in the month of December when estimates are worked on).

Finally, if the result in the year-end estimate has been negative, the mutual insurance companies that have not reached their 100% consumption commitment are responsible for this deficit.

On the contrary, if the result in the year-end estimate has been positive, the excess generated over 0.5% of the income budget (which will be returned to the General Treasury of Social Security) is reverted to those mutual companies that have exceeded their 100% consumption commitment.

In short, each mutual fund pays for the consumption made plus/minus the surplus/deficit that it is responsible for assuming.

How do you approach the project of moving to the facilities of the old Artxanda Intermutual Hospital?

We have been working on this project for years, which we face with great enthusiasm and responsibility, but with due caution, since we are aware that there is still much to do.

The truth is that it is a source of pride to see how, together, we have managed to get this hospital to maximum occupancy levels. We perceive it as recognition of a job well done both internally and in relation to coordination with colleagues from the different mutual insurance companies.

Regarding the new hospital project, we are waiting for the resolution of the DGOSS, following the application file that we agreed upon together with the central services of our Participating Mutual Funds and that we presented a few months ago.

The new hospital would be sized to meet the current and future needs of the sector, with five operating rooms, 84 hospital beds and the most advanced and cutting-edge technology, not only in terms of equipment but also sustainability, energy efficiency, etc.

What other challenges does the hospital face in the near future?

Well, as for the challenges, I think that like the rest of the mutual insurance companies in the sector and health centers in general, we face and will have to face the difficulties of incorporating and retaining our staff. In this sense, we must be creative to motivate and excite our staff in the face of the two major limitations that we observe: on the one hand, the shortage of health personnel that, I trust that the different administrations have been able to foresee to correct in the medium term, and on the other hand, the regulatory limitations that prevent us from applying a remuneration policy in accordance with our needs.

From the Intermutual Hospital of Euskadi, how do you perceive the relationship with Fraternidad-Muprespa and what do you think we can contribute to each other to strengthen our collaboration?

The relationship with Fraternidad-Muprespa, as with the rest of the participating mutual companies, is very good. We have been working together for many years and the truth is that at Intermutual we have always felt like part of the mutual company itself.

The key to maintaining this relationship and going hand in hand in common objectives is to promote the different commissions in which we jointly participate. On the one hand, the commissions related to coordinated management with the rest of the mutual societies, such as the Governing Board, in the field of general management of the Hospital, and the Medical Commission in which the medical managers of each of the participating mutual societies meet with the medical management of the Hospital. And on the other hand, the IT Commission in which the traumatology manager of Fraternidad-Muprespa meets at the national level together with the territorial medical managers and the medical management of the HIE to review and monitor the most complex clinical cases.

In the same sense, for years we have been promoting the rotation of colleagues from

Is the hospital staff aware of the differential fact of being part of a system linked to the Mutual Collaborators with Social Security? And how does this affect the way you work?

In this case, the Hospital is a Joint Center of Mutual Funds Collaborating with Social Security and, therefore, we do not serve other types of patients other than those referred by our Participating Mutual Funds, so the staff is very aware that, in addition to the quality of care, the main axis of our protocols are the patient and the mutual insurance company.

Consequently, the staff has very internalized the concepts of “delay in summonses”, optimization in transport management or any new procedure that is established as a result of the different commissions: the general ones in which all Mutual Participating Members participate and the particular ones of each mutual company.

Does the hospital have a comprehensive plan or strategy that covers aspects related to social responsibility and sustainability?

Yes. In the Hospital's latest strategic plan, its values ​​were reinforced, placing special emphasis on efficiency, sustainability and social responsibility.

How do you manage communication with the different mutual insurance companies, ensuring alignment with the needs of each of them?

The official communication system with the mutual societies is a Web Services System (API) through which the mutual societies send us their service requests and we respond by communicating the appropriate appointment. Additionally, through this system, the medical reports generated in our Hospital are automatically uploaded to the mutual insurance company's medical history.

The final phase of this development also includes the automatic loading of the images (X-rays and Magnetic Resonances) taken in our center in the mutual insurance company's application, but we still have to wait for all the mutual insurance companies to have developed their systems to establish this compatibility.

Obviously, when this project to integrate HIE information into the clinical history of each mutual insurance company began to be considered, a new Commission was formed, in this case Information Systems, to establish common guidelines for all mutual insurance companies that would allow the development to be carried out by our IT Service to be compatible with the systems of the five participating mutual insurance companies.

We can say that in this case it has been the mutual insurance companies that have aligned themselves with the IT development needs of the HIE, understanding that in this field we have more limited resources than those of the mutual insurance companies.

While the Intermutual Hospital of Euskadi sets the pace in the north, in Levante another Intermutual Hospital is consolidating itself as a leader in innovation and efficiency. Don't miss our interview next week with José Francisco Doménech, managing director of the center