“I have never IDENTIFIED WITH AN AVERAGE”
Sotirios Zavalianis is the owner of the second largest healthcare company in the Czech Republic. AKESO holding includes Hořovice Hospital, Rehabilitation Hospital Beroun and the Multiscan Oncology and Radiology Centre in Pardubice. In addition to these large centres, it operates other outpatient clinics in Chrudim, Svitavy and Ústí nad Orlicí. The group’s philosophy can be summarised by three values: human health, humaneness and helpfulness. In Greek mythology, Akeso is the goddess of healing, daughter of the renowned physician Asclepius.
And what were the successful Greek entrepreneur’s beginnings in the Czech Republic like? Sotirios Zavalianis came to communist Czechoslovakia to study at university in the year 1987. He has no problem admitting that his scholarship was paid at the time by the Communist Party. He was once described in the press as a “forced capitalist“. After completing his studies, he tried to take up some sort of employment on three occasions. The longest he lasted in a job was three months. Entrepreneurship therefore became the only solution for him. He had to employ himself. Now he employs 1,700 people. His life’s dream was to become a politician, but he wasn’t willing to slip into populism because of a political career.
We met with Mr. Zavalianis in AKESO holding’s headquarters in Prague 5. Given the pandemic, our meeting took place without shaking hands, in compliance with social distancing rules and in masks. After all, safety is one of his hospitals’ priorities. I was interested in what it’s actually like to do business in the area of healthcare. From interviews with many foreigners, I know how highly rated Czech healthcare is, and at the same time how little Czechs appreciate it. And how we’re so used to everything being free. Or at least officially. We also talked with Mr. Zavalianis about how the pandemic has affected the operation of hospitals. The Israelis claim that the pandemic pushed their healthcare system 10 years ahead. What’s the situation like in the Czech Republic? And finally we also arrived at the question of how Czechs care for their health. I hope that this interview, which still falls into a series of motivational New Year interviews, will also encourage some readers to not only think about, but also change, certain habits or stereotypes.
And how to start? Experts recommend focusing on physical exercise. In neighbouring Slovakia, Denník N (N Daily) launched a campaign accompanied by instructional and motivational articles, which aim to prepare even an untrained person for a half marathon in three months. And so I, a die-hard opponent of running, also said I’d try it. The first week seemed easy to me. I went for two 30-minute walks, and twice I alternated running and walking in 3-minute intervals for a period of 30 minutes. Surely almost anyone can manage that… so who’s coming with me?
Mr. Zavalianis, the first question will focus on entrepreneurship in healthcare. Czechs aren’t used to combining health and business. However, your AKESO holding is doing well.
Yes, we’re doing well, and we’re glad. Let’s think about why Czechs perceive entrepreneurship in healthcare as unethical. For many years, politicians acted as saviours of the nation. Their premise was free healthcare, under the control of politicians who will ensure that it’s at the right level. However, the politicians never said what care, and in what quality, they will guarantee. Thus, a myth was born which disconnects healthcare from economic reality. Unfortunately, there is no human activity which is not connected to the economy. It’s always a question of whether the money was spent efficiently, or not. And we know that, in the case of healthcare, funds were often spent inefficiently and the level of the provided services fell. Instead of keeping pace with the EU, we began to sink. Below-average managers will find it hard to attract top experts. And why is the question of whether an economic perspective belongs to healthcare only asked in connection with operating a facility? After all, pharmaceutical companies manufacture drugs and sell them to hospitals. Other companies provide high-end devices, while others again build hospitals. In those cases, an economic approach isn’t a problem? I don’t understand it. We’re trying to do things completely differently. We place emphasis on efficiency, safety and accessibility. However, the claim you mentioned is deeply rooted in people’s minds. Many believe that the private sector cannot be ethical or humane, and that its aim is to harm society. Only the state or region can protect health. Unfortunately, this original ideology, which was presented to citizens under the previous regime, has survived even in the time of capitalism.
How has the operation of your hospitals been affected by the Covid-19 pandemic? I read that you had to postpone 700 planned operations. On the contrary, your medical supplies expenses increased by 70 million CZK. Combined with the limited outpatient care, the pandemic may have cost the company as much as 100 million CZK.
Perhaps the question should instead be phrased as how Covid-19 affects us, as people. With some hyperbole, we could say that our hospitals are standing firm and will continue to function, but the question remains whether we, the citizens, will endure this situation… it has already been going on for a long time, and it will go on for some time still. But now to operational matters. The pandemic has a huge effect on the facility’s functioning. We adapted all operations to patients with Covid-19, which is good. We must take care of these patients. However, I also see the negative impacts of the fact that these patients are to a certain extent prioritised before other patients. We don’t have so much time for prevention. People are also dying from other diseases. We may be successful in treating the pandemic, but people will die due to the neglect of other illnesses.
Despite the pandemic, you’re preparing large investments to open more hospitals.
We’re planning to open a Diagnostic Centre in Butovice, Prague. It’s really about making available certain services, such as preventive examinations and regular check-ups, to patients in Prague. We want to save them the 35 kilometre journey. We have a 5.8 billion CZK investment plan for the next three years! A unique project will be the 1.2 billion CZK Mental Health Centre, which we’ll build in Beroun. In Beroun, we’re also completing a kindergarten for employees’ children, preparing operating theatres, and expanding the capacity of the inpatient facility. In Hořovice, we’re completing the construction of 100 apartments for employees, and we’re going to start the construction of another 135. In Hořovice, we’re also going to build a new hospital according to a concept which will allow for a fast change from a regular operation to an infectious disease department regimen. That way, we’ll be even better prepared for the next pandemic.
Let’s now focus on your employees. When I read interviews with you on social networks, where I follow you, you always thank your employees and present the chief physicians. We’re conducting this interview for Czech and Slovak Leaders magazine. So what type of leader are you?
Calculating? (laughs) Our activities cannot be replaced by robots or machines. If we want to be successful at what we do, we must look after those who perform these activities. In order for the facility to function well, it must be staffed with quality, responsible and satisfied employees. I’m not a philanthropist or a Samaritan. Our type of business requires a certain level of conduct. And we take care of our employees accordingly. We provide our employees with housing and affordable care for preschoolers, starting with children one year of age. In addition to these material benefits, we strive to ensure that all employees have social security in their lives so that they can focus fully on their work. Three percent of their salary goes toward additional pension insurance. And we take great care to ensure that there’s good collaboration and mood within the team. Summer camps, outings and vacations are a matter of course.
We fully stand behind and support our employees. It happens that, with the enormous number of procedures and volume of work, someone can make a mistake. I’m proud of the fact that, in almost 20 years of functioning, none of our employees has been prosecuted. We also stand behind our employees if they find themselves in a difficult situation. We’re not a corporation which views people as part of a proverbial wheel which will be replaced even if it starts to snag just a little. None of our employees is facing distraint proceedings. We offer legal assistance, as well as economic and insurance advice. We know that when a person has problems, they can’t fully concentrate on their work and the error rate increases. We rely on first-rate performance, and we want our employees to treat patients and make decisions with maximal commitment and concentration.
Let’s now move on to trends in healthcare and medicine. Israelis say that Covid-19 pushed the Israeli healthcare system 10-20 years ahead. The fact that Israelis are so far ahead in digitisation allowed for the successful vaccination of a large percentage of the population in a short time. What’s the situation like in our country?
Yes, technological progress is indisputable, and can be seen in the Czech Republic too. Consider how many new technologies were created during World War I and II. And now we’re at war with Covid-19. More experts, but also financial resources, are focused on the field of healthcare and pharmacy. In our company, we had to come up with completely new procedures and processes with regard to safety and effectiveness of treatment. Suddenly, healthcare comes to the forefront of the attention of all sections of the population. It’s important for everyone. Previously, young, healthy people weren’t interested in the state of the healthcare system, because they hardly needed it at all. Suddenly, it turned out that anyone can fall ill.
Our hospitals have also been operating “paperlessly“ for many years, but Czech legislation isn’t very progressive in this respect. Digitisation by itself won’t save the day; it’s very overrated. It won’t replace doctors or nurses. We digitise a huge volume of information, but can we process and use it? And for what? Maybe eliminating bureaucracy would suffice. Digitising our bad habits into a 0 and 1 system really won’t move us forward. Did you know that nurses spend as much as 80% of their time on administration? I can see that processes are far more important for effective, efficient and above all safe treatment than digitisation, but that’s what attracts media attention.
How do you see the future of medicine and the medicine of the future? Is it new technologies, such as for example nanotechnology? Or, on the contrary, a return to natural medicine such as medicinal cannabis?
One thing is certain. We must all die one day. What’s medicine for? For a quality and long life. Today, in the Czech Republic, men are living to 76.2 years of age, and women to 82.1. However, we only live an average of 61 years in good health. Medicine should enable us to live as long as possible, with the highest possible quality of life. And, in our hospitals, we’re contributing to this. We can’t rely on miraculous healing. We try to use new inventions and innovative approaches. We use biological treatments, including work with cannabis. But I’d say that in the case of cannabis, just like digitisation, it’s a kind of overinflated bubble. There isn’t that much interest in cannabis among patients.
And then there are real problems here. I’ll come back to the issue of mental health. Did you know that more than 3.8 million people have mental health problems? In the Czech Republic, I see almost excessive trust in and reliance on healers and saviours, often very false ones. That’s why I recommend that people begin their treatment with a doctor, and use alternative therapy as a supporting measure. Unfortunately, on too many occasions, I have encountered cases where women with cancer, in particular, came into surgery with the disease at a too advanced stage, because they prioritised alternative therapy.
Let’s take care not only of our bodies, but also our mental health.
Do Czechs take care of their health?
Some do. But a huge number of people come to see their doctor too late. Look around the street, and you’ll see a large number of people who are obese, even at a young age. 23 percent of the adult population is obese, while another 30 percent is overweight. A large part of the population therefore doesn’t take very good care of its health. The setup of the current health insurance system doesn’t motivate people very much to look after their health. High-risk behaviour should be penalised, and the motivation should focus on care for one’s health. It’s not just about the individual, as we often believe. The cost of increased care comes out of all our pockets. Healthcare should be a society-wide interest. Much money would be saved, and hospitals wouldn’t be so overcrowded.
And to conclude?
I have never identified with an average. If I identified with average, maybe I’d have an easier life. As soon as someone juts out of the average, the others try to chop their head off. So I’m glad that our hospitals are among the above-average ones. We don’t use the word “average“ in our company.
By Linda Štucbartová