Q&A With Spain's Ribera Salud: COVID-19 Impact and Planning for a New Normal

Business, International


hospital worker in protective equipment

Ribera Salud, Centene's hospital system in Spain, has begun adjusting to a new normal and preparing for an uncertain autumn in a country that has been one of the hardest hit by COVID-19. Ribera Salud operates six hospitals with more than 1,500 beds, employing more than 6,200 professionals in Spain. That includes the Torrejón Hospital in Madrid, the epicenter of the Spanish outbreak.

Spain recently reported its first 24-hour period without a COVID-19-related death since March. Still, the country’s mortality rate is the second-highest in Europe, and the rate of infection among healthcare workers ranks highest at 20%. Ribera Salud, however, managed to significantly limit its workers' infection rate to 3.4%.

"This is one of the best examples of the work well done in all the group's hospitals, prioritizing both the care for our patients and the safety and health of our professionals," said Ribera Salud CEO Alberto de Rosa.

According to de Rosa and his executive team, Ribera Salud's success in limiting infection among its frontline staff came down to a focus on communication to employees about safety and prevention, increased training, and the adoption of preventive organizational measures. This including increasing staffing and shift flexibility to decrease overall exposure to the viral environment.

What follows is a Q&A with de Rosa and his executive team.

Q: Now that the infection and mortality rates are on the decline in Spain, how have day-to-day operations at Ribera Salud hospitals changed?

A: A weekly plan was designed for each service and healthcare area (operating rooms, outpatient consultations, radiology, endoscopies) for the progressive recovery of the non-urgent, scheduled activity that has been delayed during these last two months by the pandemic.

The plan that is being implemented guarantees, to the extent possible, the safety of the healthcare provided to patients and also the safety of the healthcare professionals who provide it. In this way, the patients who are going to have an operation or undergo an invasive diagnostic test verify that they do not have an active COVID-19 infection by using PCR and serological tests.

In outpatient consultations, waiting rooms have limited the number of patients who can stay, which allows a safe distance from others. At the hospital’s entrance, a temperature measurement is taken to detect fever. If a patient does not have a face mask, we provide one.

Q: Spain is set to slowly begin loosening its nationwide lockdown. How do you prepare your hospitals for potential spikes in COVID-19 cases as business and social life begins to pick up?

A: The emergency care circuits for patients with suspected COVID-19 infection (fever and respiratory symptoms) remain active. There are defined hospitalization areas for the treatment of patients with already diagnosed or suspected COVID-19 infection, pending confirmation. ICUs have 20% more beds enabled in case of a spike.

Q: What are you doing to help ensure that your staff is able to get some rest after a very difficult period?

A: We have extended the new reinforcement contracts to be able to give days off to the personnel who have had a greater workload during these last two months. In addition, we're taking advantage of the decreased volume of typical health care-related activities—i.e., elective procedures, etc.—and the drop in COVID-19 hospitalizations by decreasing staffing levels. That allows our professionals additional down time.  

Q: How would you assess their current morale, and what supports are in place for their mental health?

A: Now you can see the end of this long tunnel, and that helps. It is true that we must continue to closely manage and monitor the situation, and that is why we’re continuing the psychological support program that we started at the beginning of this crisis to all the personnel who require it through individual and group sessions.

Q: Many experts are worried that we’ll see a resurgence of the virus in the fall and winter, combined with the typical flu season. How is Ribera Salud thinking about and preparing for that possibility?

A: We have prepared a follow-up plan taking into account that there will continue to be COVID-19 patients regularly requiring care. We also have a plan to be prepared in case there is an upturn of cases and we are ready to double the capacity of the hospital and triple the capacity of ICUs.

Q: For many of your patients, surviving the novel coronavirus was a frightening and isolating experience. What measures are there in place to ensure that they have behavioral health support after they are discharged from the hospital?

A: An emotional support and physical complications monitoring plan has been designed and is already being evaluated. A research study has been designed including all the cases in the group.

Q: How will Ribera Salud be involved with public education campaigns about hygiene and other safety protocols, such as mask-wearing, to diminish the likelihood of a resurgence of the virus in your communities?

A: We are actively participating in all campaigns with our professionals and with the community to reinforce health education and prevent contagion.


As the COVID-19 pandemic continues to evolve, the safety of our employees, provider networks, members, and communities remains our uncompromising priority. For more information on how Centene is addressing the COVID-19 pandemic domestically and internationally, visit our Resource Center and experience the perspective of our partners in the U.K.