COVID-19 Q&A With Ribera Salud Leadership

Business, International


healthcare workers wheel gurney down hospital hallway

The experience of Centene's international operations in the UK and Spain has allowed us to better understand the potential impact of COVID-19 on domestic healthcare systems. COVID-19 hit Spain harder than any country in Europe, except Italy. More than 200,000 people have tested positive for the virus across the country and more than 20,000 have died.

In Spain, Centene subsidiary Ribera Salud operates six hospitals with more than 1,500 beds, employing more than 6,200 professionals. That includes the Torrejón Hospital in Madrid—the epicenter of the Spanish outbreak—and its Torrevieja hospital in the Valencia region. The virus forced health authorities in Madrid to rapidly expand ICU capacity, and Ribera did the same for its Torrejón hospital. General admission beds increased by 60 percent at Torrejón, while the number of ICU beds increased from 16 to 34. COVID-19 cases occupied the majority of the hospital’s beds (58 percent) and 56 percent of its ICU beds.

Today, Spain is emerging from the worst of the outbreak. What follows is a Q&A with Ribera Salud CEO Alberto de Rosa and his executive team, lightly edited for space and clarity.

Q: How have you been able to maintain appropriate staffing levels, given how many healthcare workers have had to self-isolate because of exposure to the virus?

A: We used five key strategies: exchanging professionals within different projects so that they had more COVID-19 training and protection; hiring reinforcements to stand in for those who were out sick; adjusting shifts to prevent exposure to the viral environment; actively detecting symptomatic cases and acting proactively, and by hiring students from our own nursing school.

Q: What steps have you taken to help maintain the morale of your doctors and nurses?

A: We have acted on a couple of different fronts to address the long-term needs of our staff and to help ensure that they feel supported in the moment. On the long-term side, we instituted psychological support for professionals, coordinated by the Psychiatry Department, and put a plan in place to help ensure work-life balance.

In the near term, we are providing free food for our professionals and have entered into agreements with external organizations to help make the lives of our nurses and doctors outside the hospital as easy as possible, such as help with tax payments or with securing accommodations close to the hospital. We also created a website to receive expressions of support (letters, drawings, audio, etc.) from our community members and produced videos to show our appreciation for our staff—from doctors and nurses to cleaning staff.

Spanish society continues to express its solidarity with our workers, and that means a lot. Every day at 8 p.m., Spaniards and Spanish law enforcement take to their porches and balconies and open their doors and windows to clap and cheer for our professionals.

Q: What have you learned from your experience in Torrejón (Madrid), and how have you applied it to the Torrevieja hospital and to other hospitals in your system?

A: The main thing is that we were able to foresee the progression and speed of the pandemic. We transferred everything we learned to the other projects: creating spaces, collecting material and equipment, addressing clinical practice and human resources, and modifying communication with patients and family members.

We’ve learned many lessons from this crisis: First, in a time of crisis, and particularly in a crisis like this—a new crisis, an unknown crisis—plans last just one week. We need to be flexible in adapting to an evolving situation.

Second, you have to work to get one step ahead of COVID-19. Fast and effective internal communication, as well as continuous analysis and prediction of different scenarios, are essential.

Third, the leadership within the organization must be a professional and clinical leadership. All departments (technology, purchases, general services) must be completely aligned to support our clinicians so that they can act effectively.

 Q: For hospital administrators and healthcare executives in the U.S. who are still in the early stages of dealing with the coronavirus outbreak, what are the most important things for them to consider?

A: There are the obvious things: having testing capacity and supply in place to be able to test patients and staff and ensuring the availability of equipment, i.e., PPE (personal protective equipment) but also beds, respirators, flowmeters, etc.

As for planning and management at the hospital level, you have to be able to plan for increased capacity per hospital, hospitalization wards and ICUs and enabling isolation and follow-up at the patients’ homes by primary care providers.  

Q: Has anything evolved in how you care for patients who present with COVID-19 symptoms?

A: Yes, there have been a number of adjustments, including the identification method for symptomatic and asymptomatic patients and the utilization of different tests. The guidelines are continually modified and clinically adjusted.

Q: Healthcare workers are accustomed to having to deal with new and emerging threats (SARS, Zika, even HIV), but as individuals providing direct care, what has surprised you about the COVID-19 outbreak?

A: Its speed, high infection rate, the speed at which it brings the healthcare system to a standstill and the mortality rate in absolute numbers.

Q: If you could go back in time, what advice would you give to yourself before the novel coronavirus came to Spain that would help you prepare your hospitals and workforce for the challenges you’ve seen?

A: I would ensure that we are able to buy all the supplies we will need and have contingency plans in place before they are necessary. It’s important to encourage the government to take special measures regarding nursing homes, so that an influx of elderly patients does not overwhelm hospitals.

I would also be aware that this is a reality that other countries have experienced, and it is devastating because of the speed that it spreads at and its high and intense impact on the healthcare system. I would make the community, hospitals, primary care centres, and professionals aware of the fact that it is very serious. I would insist on training everyone on the correct preventive measures. This is a serious problem, and it is important to give it the visibility it deserves, to not make light of the situation.


Centene is deeply grateful for the insight of Alberto de Rosa and all of our strategic leaders. As the COVID-19 situation evolves, we’re continually refining the best ways to keep our employees, members, and partners safe and healthy. For more information on how Centene is addressing the COVID-19 pandemic domestically and internationally, visit our Resource Center.