00:00 Radek: Hi, welcome to another episode of the Design and Business podcast. Today, once again, we'll be talking about medical facilities, this time with our guest, Ewelina Barylska. Hi Ewelina.

00:12 Ewelina: Hi Radek.

00:13 Radek: This is our second meeting. Unfortunately, due to technical reasons, we had to scrap the first recording and meet again to chat.

00:22 Ewelina: No regrets.

00:23 Radek: Me neither. We had a great conversation, and I hope today we'll cover those same topics as last time. And those topics are primarily medical facilities from a business perspective – meaning, can a medical facility operate like a business – and on the other hand, the patient's perspective – how to manage patient emotions throughout their journey, so that the entire treatment process is not only effective in terms of recovery, but also pleasant, calm, and safe for the patient. So, I invite all of you to listen to this episode.

01:11 Radek: Ewelina, when we last met, you were the Director of Operations at Salva Medica. I know things have changed a bit. Could you tell us what you're doing now? Where are you based?

01:22 Ewelina: Yes, indeed, the location and workplace have changed, as has the city. But what hasn't changed, 

04:57 Radek: That's very interesting what you're saying. During our last conversation, we also touched on how we communicate certain things, specifically regarding treatment. And here you gave the example of fertility treatment. I usually encounter the term 'infertility treatment'. And you said something very interesting about reversing that concept.

05:19 Ewelina: Yes, and you know, these words... personally, when you asked about mission or values, I also pay a lot of attention to how we choose our words, because they carry a lot of weight, especially in an area fraught with uncertainty and stress. And there was a moment, of course, at Salve, when we were working on this aspect. I believe changing that communication was an excellent idea, because 'infertility treatment' already carries a more negative connotation, implying the resolution of a problem, whereas using terms like 'fertility treatment' or 'fertility support' shows that everyone possesses fertility, but some have it to a lesser or limited extent, and it simply needs a little assistance. So, I think that's a much better message than one that's already tinged with negative emotions and immediately suggests there's a problem, because it's not always a big problem. 

06:24 Radek: And this really leads us to the whole patient journey and what it truly is when it comes to treatment. Because in service design, user experience design, patient experience, emotions play a crucial role. You could say that this experience is like a timeline where certain emotions unfold. When it comes to treatment, to health, there are a lot of these emotions, especially negative ones, those that strongly influence how the user or patient feels. So now, could you tell us what these journeys mean to you, how you work with them, and how important emotions are in the treatment process?

07:13 Ewelina: You know, I think they're very important because there's quite a significant mix. As you said, there are many negative emotions – anxiety, fear, apprehension about the unknown, about illness, about family difficulties. But on the other hand, there are also many positive emotions, such as hope, excitement, or, when we talk about fertility treatment, it's the anticipation of a positive outcome, right? There are small steps, small improvements. Again, from my new area of work at Vratislavia – we're talking about rehabilitation, about longer stays – these are moments where you see progress as a patient, as a family, and that hope flickers more and more. And then you see that the motivation to continue treatment or exercises, in this case, is much higher. We currently have such a program at Vratislavia. I didn't even know such initiatives existed, and I think it's a really great one. We're implementing an agreement with the Social Insurance Institution (ZUS) for what's called 'disability prevention,' and ZUS sends patients to rehabilitation stays specifically to help them regain fitness and return to the workforce after various types of accidents. We now have a patient, for the first time, who decided to apply to ZUS for an extension of this stay, which simultaneously involves giving up their disability pension. Those are the conditions.

08:38 Ewelina: And now, when I heard about it, I thought, 'Wow, that means this gentleman saw such significant progress after the first stay.' He's a young man who simply wants to become professionally active again, rather than relying on those disability benefits long-term. He saw that he could fight for his fitness, that he could regain it, that he was on the right track, and he was willing to take such a big risk – to give up his pension – precisely to continue rehabilitation. And that's fantastic, so this is also part of those positive emotions that we might not immediately think of. Exactly, even, look, as you yourself said, right? Medicine, illness, negative. But you can evoke, show – because they exist, we just might not notice them daily – these positive correlations, these associations, fertility instead of infertility, and with such small things, cause big changes, so that this mindset, this way of thinking about the approach to treatment, gives hope, gives the will to fight, and not resignation, which later significantly impacts how the treatment ultimately progresses.

09:38 Radek: Are there any examples of changes that have successfully improved the traditional oncological treatment pathway we currently have? Or what challenges do you observe within that pathway?

09:54 Ewelina: A lot, you know, when you delve into that level of the patient journey, and it seems to me, or rather, I don't think I could have managed it any other way than by truly going into detail on this pathway. And if this is a key pathway in your organization, if someone watching manages an organization, then I simply believe it's worth putting it on the table, gathering the team, and spending time to analyze step-by-step what the patient experiences. Because it's not just about medical procedures.

10:23 Radek: No, exactly, what does such a patient encounter. What influences these emotions, right?

10:26 Ewelina: Let's take the woman who has a mammogram, we detect some change. Well, okay. And she should then go through the next stages of treatment in the system. The woman is from a small town where the Mammobus has arrived. It's great that there's such a program in Poland for years now that reaches such places with limited access through mobile units. I don't know if you know, because you're a resident of a big city, just like me, but the problem is already so acute that if I remember correctly, a year ago there was even a special panel at the Health Market called exclusion by postal code. Showing how access to healthcare differs depending on the place of residence, because many bus lines that used to exist have simply been eliminated. And I mention this only to highlight how important it is to delve into detail. Because such a woman, wanting to access further stages of treatment, often needs to involve someone from her family. So she comes for a visit where she has an ultrasound done. At this ultrasound, it may turn out that a biopsy is necessary. And here was one of the examples we optimized on this pathway. Because it turned out in discussions with doctors that in most cases where the so-called BI-RADS is defined, meaning the stage of advancement of the tumor is at a certain level, in ninety-some percent of cases, this biopsy will be indicated. So we changed the pathway in such a way that the patient is already registered in such a way that we have time to perform the biopsy in one instead of two visits. So this is a real step towards the patient, so as not to unnecessarily bring them to the hospital more times than necessary, because that also involves.

12:02 Radek: It stresses him.

12:03 Ewelina: Exactly. And this is just the beginning of the pathway, because then those visits, if there is treatment, whether surgical or in surgical, the time is shorter, but it's rarely the only treatment, so often chemotherapy is also added, and it is a repeat cycle, so that involvement of the family and again those... I know how this will sound, but that's how patients think about it, and I say this with such certainty because my grandmother also passed away due to cancer, and I was very close to that perspective of family, observing her emotions. And she felt, like probably many other patients, guilt for involving and asking someone to take her to the hospital. So those emotions build up, that frustration caused by the fact that she is involving someone, those are several-hour stays, once every two weeks, or once every three, so there is indeed quite a lot of that, but at the same time, in the meantime, there are imaging tests, and we check whether the treatment is effective and whether the tumor is shrinking, or whether the treatment is ineffective and the tumor is not shrinking. And depending on what the verdict is, such emotions arise there, because if it shrinks, then that positive emotion appears again. You know, that hope, that expectation that it is getting better. That mutual uplifting. I think I mentioned this to you recently, but I think it's worth repeating since our previous recording somehow got lost.

13:25 Radek: Dla słuchaczy to będzie pierwszy raz powiedziane.

13:28 Ewelina: Natomiast to jest jeden z takich momentów w mojej ścieżce  zawodowej, który bardzo zmienił w moim postrzeganiu właśnie ścieżek pacjenta  moje podejście do tego. To był moment właśnie przeczytania takiego raportu  organizacji pacjenckich właśnie dotyczących onkologii. O tym, że pacjenci  onkologiczni jako moment największego niepokoju na całej ścieżce nie 

wskazywali momentu, w którym mieli postawioną na diagnozę, czy byli w trakcie  leczenia, tylko moment, w którym była wizyta, na której się dowiedzieli, że koniec leczenia.

13:59 Ewelina: I może to się wydawać dziwne na początku, tak jak się o tym usłyszy,  ale z drugiej strony ja bardzo dużo o tym myślałam. I zrozumiałam też dlaczego,  bo jednak pacjent, szczególnie być może onkologiczny, który jest w takim  procesie w kilku miesiącach, a może czasem nawet latach leczenia, ciągłych,  bardzo częstych wizyt i bycia pod okiem medyków, specjalistów, mając wykonywane różnego rodzaju badania. Nagle słyszy, że jest zdrowy i wraca do  domu i nie ma kontaktu już z tymi medykami.

14:32 Radek: Nie wiadomo co się może wydarzyć.

14:33 Ewelina: And the anxiety associated with no one monitoring them anymore, and the possibility of the cancer returning, is so significant that it's often the most anxious time for patients. And again, what can be done? A lot can be done in this area, because you can more frequently offer the patient what's called a follow-up. You can encourage them to participate in very active patient organizations in oncology, such as for breast cancer – the Amazons. For men with prostate cancer – the Gladiators. Many patients also very willingly use, and this is a fantastic source of insight into patients' emotions, anxieties, and fears, patient Facebook groups, which simply unite people. The fact that they are so numerous and there's so much activity in these groups indicates that these patients desperately need support. But if you log into any such group, whether it's about breast cancer or, for example, fertility treatment, you'll see that there are not only patients but also families who advise each other and ask other families, or even ask patients, how they can support, how they can help. What to ask about, and what they shouldn't ask about. So, it's a very good place to grasp where patients' emotions are, at what stage. And for example, again, from the realm of fertility treatment, in such a Facebook group where patients share their experiences, there are posts that personally move me deeply, where patients decide, for example, to end their treatment after many years of no success. And they make a farewell post. And what happens in the comments there, the support, those words of encouragement, are priceless. Because this is precisely about a broader perspective – you know, it's never just about that one problem. It's also about our societal approach, for example, to fertility treatment, whether it's accepted, or if the family even knows. Unfortunately, there are more aspects to it, so it's not just that these patients are dealing with a medical problem and the inability to fulfill their dream of having a child. But they might also be dealing with the fact that it's stigmatized in their environment, that they are alone in this, that every holiday they hear wishes for offspring. Or that aunts nudge them with their elbows, asking, "So, when's the baby coming?" And internally, they are experiencing a tragedy. So, many things can be planned in communication to support patients, to equip them with social media posts or pre-holiday newsletters containing phrases that can be created with the support of a psychologist, to tell these patients, "Everything is okay with you." And if someone asks you about aspects you don't want to discuss because they are too difficult for you, you can respond in such a way – you know, even such simple examples.

17:14 Radek: My impression is that a lot could depend on the doctor and their specific role. The information I get even from my doctor colleagues is that because they are burdened with so many administrative tasks – like operating specific software and adhering to various regulations – they don't have the capacity or the time to truly care for the patient. They even lack the tools to address the things you're talking about. One patient might need support with specific tasks, meaning you'd have to list out concrete steps for them, point by point. Others will need more reassurance, a comforting word, that kind of emotional support, and in my opinion, that needs to happen right there in the consultation room.

18:08 Ewelina: Yes, I completely agree with you, and this aspect is very complex. On one hand, today's expectations of doctors – formal, systemic, and from patients – are very high. On the other hand, there's often – and by 'there' I mean among doctors – a very good intention and a desire to cure the patient. But then again, there are limited time resources, or simply limitations in their specific expertise or knowledge. From what I know, based on my many conversations with doctors who are aware and looking for something beyond the standard treatment path and the multitude of specialized courses they continue to take... Being a doctor is constant learning, and perhaps that's not immediately obvious.

18:54 Radek: There's immense pressure, because if they make a mistake, they're exposed to very significant risks. And they can't afford that, so I understand why they cling so tightly to their expertise and their profession, and tend to overlook the psychological aspect a bit.

19:12 Ewelina: Yes, there's definitely a lack of providing tools, even just in the form of training and easy mechanisms for recognizing – and this might sound a bit high-minded – personality types. The goal is to tailor communication to the patient on the other side, precisely to make it effective. As you rightly said, one patient will need everything written down precisely on paper, because they'll forget everything the moment they step out the door. Another will need much more empathy, a more gentle way of being told things. So it's hard to generalize.

22:51 Radek: We were just talking about empathy recently. Specifically, how to study it, how to apply it. You told us about a tool called Empatizer. Right.

23:00 Ewelina: A really great tool. 

23:02 Radek: I think such tools could be... useful for treatment? I think so.

23:10 Ewelina: We're not there yet, so maybe that will be a good reason for another conversation later. But you know what, we're not there yet, and I'll just say, with your previous guest, Ms. Agnieszka Siennicka from the Medical University of Wrocław, we've arranged to conduct a staff study. 

Regarding cognitive empathy, if I'm not mistaken, we'll be speaking with mid-level staff, specifically nurses. We'll see what those results reveal, as the University is conducting a slightly broader study in this area. Since we're already collaborating closely here in Wrocław, both I and the hospital would be very keen to get involved to investigate this further. Perhaps we can then enhance, through tools or training, and certainly with insights from these studies, the approach of medical professionals towards patients who require diverse communication methods. I don't know if you're aware, but there was a controversial study where patients found a chatbot, specifically, to be more empathetic than a doctor.

24:17 Radek: Yes, many people actually use chat for self-therapy. This is precisely because it can maintain a language and communication style that resonates with them.

24:30 Ewelina: It simply doesn't have the emotions that the other person on the other side has. However, when it comes to – I am a big enthusiast of using technology, especially to take certain processes off our hands, processes that we don't need to do as humans. But if we're talking about medicine, we also need to be aware that doctors and all medical professionals have the right to expect these tools to be safe, not to be too far-reaching and intruding into areas they shouldn't touch, as they are tools, not professionals. So this discussion, of course, isn't just about medicine, but constantly, when we talk about artificial intelligence, the question is, who will it replace? And that's precisely regarding this negative connotation.

25:14 Radek: Why don't we ask, who will it help?

25:16 Ewelina: Exactly, so everyone then feels in a threatened position. So, will AI replace doctors? I approach this by saying that we shouldn't be wondering whether AI or a doctor is better, but rather, we should be asking if a doctor who uses AI is better than one who doesn't. Because I think the one who uses it will simply optimize their time better, and their proportion of time spent looking at the patient versus time spent looking at a monitor will lean towards what satisfies both.

25:50 Radek: I'd say it's not so much about which doctor is better, but rather whose work will be more effective. 

25:58 Ewelina: Exactly. You know, when there's time, as you mentioned, for creating medical documentation, for all the bureaucracy, for issuing referrals, prescriptions – all of this happens today, these tasks are ongoing. Of course, it's well-known that the needs here are usually greater than the capabilities, but it is improving, even if it's not yet dramatically visible. But precisely, once that time is recovered, the doctor will be able to dedicate their attention to the patient. Because, you know, there's another layer you don't see yet. I know I'm talking about something mundane, but besides the fact that it's a system where you have to fill in countless fields, they don't always work. Sometimes the connection fails, whether it's with the P1 platform, or simply, I don't know, the internet isn't working, or the system lags, or the computer is old. And the doctor, with the first and second patient, might not be so frustrated by it yet. But by the 40th patient, and when it's already another day of the week where problems repeat, he's already frustrated just because he doesn't have good tools to work with. He has to compensate for these systemic shortcomings himself, while simultaneously staying focused and empathetic. And it's sometimes simply difficult to reconcile all these roles, and then at the end, be aware that the patient will write about it, encouraged by the portal through which they booked their appointment to leave a review.

27:13 Radek: And this is where the patient's journey intersects with the doctor's journey, the staff's journey, and so on. This also needs to be seamless for the entire experience – the whole treatment process – to be successful. You also talked about ways to improve the... patient's journey and the doctor's journey. For example, some tasks could be handled by a survey, or by an assistant who conducts an initial interview before the final visit.

27:50 Radek: These are the kinds of things that come from a facility being well-managed. And a lot depends on that management. What I'm observing now, and what makes me very happy – and we actually discussed this recently – is that a medical facility should view itself a bit like a business. Because what we've been talking about is essentially how any growing, competitive business operates, whether it's selling a product or a service. They simply take care of these things to ensure the final user or client is satisfied. Now, when it comes to medical facilities, at least from my perspective – and I think this is true for most of us – there's this ingrained thought: 'No, no, it's a medical facility, we treat people, we can't possibly call a patient a lead.' And you were the first to say it, which really positively surprised me, because we genuinely need to treat patients as leads. We have to ensure these leads are valuable to us, that they are well-cared for, that they want to return, or at least have a positive experience, right?

28:59 Radek: So, are medical facilities really starting to become like businesses now?

29:06 Ewelina: I think those... that have good results, and by good results, I mean not just good financial results, but also patient reviews and recommendations, then yes. Because however it may sound – perhaps that a patient is a 'lead,' and it does sound soulless – I believe that a patient treated as a lead, meaning a potential client, is a patient who receives excellent care from the facility. This is a patient whose call will be answered. Or who will be called back, or called to remind them they have a referral to follow up on.

29:39 Radek: And it will be pleasant.

29:40 Ewelina: Exactly. Not one who is just told to wait there. Instead, you call them and say, "I noticed you have an unfulfilled referral, and it's still valid. Would you like me to help you book it?" And that's how I understand treating a patient as a lead – meaning taking care of them like any other customer. This is something we see every day in many other industries, which are often more advanced than the medical sector. Perhaps the medical industry is complex – and everyone probably says that about their own field – but maybe it also stems from the fact that we deal with important, serious topics, the highest value: human life and health. So, these other aspects, which might seem less important to us, we tend to push to the background. Meanwhile, it turns out they are very significant, and personally, I believe that competition actually has a positive effect, because patients, having more choice, are becoming increasingly aware and expect a certain standard. So, it's no longer okay for a patient to wait an hour past their scheduled appointment time. No, it's not okay that a patient coming for chemotherapy every three weeks doesn't get a specific time, but simply shows up and has to spend the whole day, without really knowing if it will be two or seven hours. Because it's simply not right to add extra, unnecessary stressors when there are already enough. And there are simply tons of such things, such small details that can be taken care of, even visually, in a facility. So that it feels pleasant, warm, so it's not that stiff white bedding we all know from hospitals. Because you really can reconcile epidemiological and hygienic aspects with making the patient feel very pleasant and cozy in the place they spend time.

31:30 Ewelina: When patients at Vratislavia spend over twenty days on their rehabilitation stays, it becomes their second home for a long time. They host friends and family there. The hospital is built in such a way that there's an open-air courtyard. And it's incredibly pleasant, even for me, I must admit, when I walk through the hospital corridors and see that on sunny days, patients with varying degrees of mobility, some in wheelchairs, are sitting in that courtyard, reading a book, or receiving visitors. It's very motivating, and you know, that's when you realize it truly makes sense, that it's needed. Or, for example, a sensory path – essentially a small track in a mini-park with a bridge – is also built outdoors to show patients that it doesn't always have to be a technical exercise room and climbing stairs. Because when you do the same thing surrounded by a few trees in the sun and on different surfaces, you sometimes even forget you're exercising, yet you get the same good results. So there are many such things; you just need to be willing to fight for them. And I think it comes down to this: to stop being in the position where we think we'll have patients anyway. That's probably true, but they won't be patients who come by choice, but out of necessity. And those won't be entirely satisfied with how the service was delivered to them.

33:05 Radek: And they also won't have a positive patient journey if we don't take care of it. But exactly, because all of this is really easy to say. A medical facility as a company, and now to compare it... well, you can't compare it to a commercial, ordinary business. That's because there are certain regulations. It's a different industry after all. Medical, probably administrative, financial regulations.

33:29 Radek: You could probably list quite a few. These are likely significant blockers. What exactly are these blockers, and how can we overcome them?

33:37 Ewelina: You know that the medical industry in Poland, but also beyond Poland, is a highly regulated industry, and we are probably – I don't know if not the only industry, but certainly one of the few – that even has minimum employee wages defined by law, if I remember correctly, for the past four years. So, you know, if you're running a business – a hospital, that is – and you provide services under the National Health Fund (NFZ), then the prices are set and recommended by the Agency for Health Technology Assessment and Tariff System, currently approved by the minister, and then implemented by the National Health Fund. So your revenues are, in a way, already imposed from above. Your wages are regulated, defining how they should look. And there are many other aspects that are simply very rigid. But not everything is rigid. So there are still plenty of examples, even private hospitals that have contracts with the National Health Fund, which nonetheless do things differently than others, yet receive the same remuneration. It's just a matter of willingness to approach things differently, to organize certain things within the existing frameworks, which are, of course, there, and perhaps these frameworks are quite tight, but they still leave some room. There are also a few hospitals. Over the past two years, I pursued an MBA in Healthcare at Łazarski University, and the group I had the great pleasure of studying with included representatives from public hospitals. Among them was the Medical University of Gdańsk, a hospital that is a huge inspiration for me. It's the largest public hospital, and they're doing fantastic things there, precisely because no one there seems to have convinced themselves that it can't be done. I think I'll share one example that simply captivated me.

35:23 Radek: We'd love to hear it.

35:26 Ewelina: It captivated me precisely because of how cleverly they approached ensuring a fantastic patient experience within the imposed regulations, and hold on tight, because you're going to fall off your chair. This hospital was conducting rehabilitation – I hope I'm not misremembering, but I believe it was rehabilitation after cardiac incidents. So, from a business perspective – meaning, from the company's point of view – it works like this: the patient has a certain number of specific, different exercises, and 

the hospital will only get paid if you attend all sessions – let's say six, I'm just picking a number. So if you come to four and then drop out, unfortunately, the hospital loses out because it won't get paid for you. That's the business side of things. So what does the hospital do?

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36:13 Ewelina: The hospital comes up with an idea: 'Okay, let's make the fifth and sixth sessions fun so patients will want to stick with them.' And you know what they do? They do exercises that are – I'm getting goosebumps just remembering it – they do exercises that are hippotherapy, they have sessions with horses, they have rides.

36:31 Radek: Wow.

36:33 Ewelina: The entire cycle is coming to an end, and these patients are saying, "But we want to keep participating!" because it's simply fantastic. Not only did they have their exercises, but they also built relationships, met wonderful people, and were going to the horses – and it was only their fifth or sixth session!

36:45 Radek: It's interesting how they know that the fifth, sixth training session will be... something very attractive to them, so they'll definitely stick with it until then. Great, very well thought out.

36:57 Ewelina: Exactly. And besides, you know, again, the hospital achieved the effect they were aiming for.

37:01 Radek: But they could have just threatened the patient, for example. Or, I don't know, said that if they don't do that sixth one, something bad will happen to them, or their progress will reverse. They could have forced them to come. They could have done all six training sessions at once, after all.

A lot could have been done, but someone actually thought about wanting these patients to stay engaged, to benefit from it, and to find it appealing and enjoyable.

37:24 Radek: But how does that work in a public institution?

37:27 Ewelina: Yes, in a public institution, and a university one at that. I'm specifically mentioning this because if anyone watching says, 'It's easy to talk about in theory, but it's impossible in practice,' then I invite them to see for themselves. Seriously, the people managing this hospital are so open-minded. Thanks to them, you can actually go there, arrange a study visit, and they're very willing to share what and how they do things. And that's also great because they're not afraid to say they had this or that idea. They're also not afraid to admit which ideas didn't work out. And it's precisely these kinds of institutions, working this way, that achieve success. For me, this is an example that disproves the argument that 'it's impossible for everyone.'

38:08 Radek: It's interesting how all of this ties together into one whole: if we treat our medical facilities a bit like commercial businesses, businesses that, let's say, need to generate revenue, then suddenly it turns out that the way for these businesses to grow or achieve success is by addressing patient needs. And these two perspectives – the patient's and the business's – align beautifully.

38:39 Ewelina: You know, there's another layer to all of this, maybe not the most important, but I think it's significant. That, you know, when a team in that hospital – medical staff, administration – hears something like, 'We launched this initiative in the hospital,' they're simply proud and happy that we're doing, to put it colloquially, cool and important things, things that people praise us for. And actually, in all of this, one could even say – though it might sound a bit trivializing – 'Oh, it's a public institution, so even if they don't come back for that sixth training session, it's no big deal.' After all, they can incur a loss, because the primary goal of public hospitals is simply to break even. They don't even have to be profitable. But when they consider, when they start from these needs, then it's simply a huge success. And then there's much more initiative from people who have fantastic ideas because they are closest to the patients – that is, from medical staff, coordinators, and registration employees. But, you know, they need to be shown that they can voice these ideas and that they will be heard and taken into account. And if management is somewhere from the position of a statue and one infallible person, then I also think it's simply very limited because it lacks that full spectrum. So, as you mentioned earlier about doctors and patient experience, if the entire pathway doesn't consider the experience beyond the patient – the experience of the nurse and the doctor – and we only do something focused on the patient without thinking about whether the processes for the doctor and nurse are optimal, then no matter how great our ideas are for that pathway, if it's an organizational absurdity for the medical staff, it will still impact the patient because they will simply be frustrated and dissatisfied. They won't be smiling because they simply won't have comfortable working conditions. So, you simply have to look at it holistically.

So, they really need to be above all of that.

leaders who will lead by setting visions and directions. Because I believe that to have a good team that will execute these visions, that will be genuinely fired up about what they do, and will even aim higher than I do, feeling that they are capable – well, someone needs to tell them 'you can do it.' And that is the role of leaders.

40:52 Ewelina: Yes, and that's also a big risk. Patient-centricity is a great slogan, and I agree with it in principle, but I don't agree with patient-centricity at the expense of the doctor and nurse, because then it simply won't work. If we say, 'Okay, patient, you can book an appointment at any time you want,' but as a result, we give the doctor, for example, one patient every three hours, and they end up with three breaks, each three hours long, during the day.

41:20 Ewelina: Well, that probably won't work, because then the doctor will simply get frustrated and their work won't be optimally organized. You need to try and find a balance in all of this. I'm not saying it's easy, because these are significant challenges that need to be faced, but I think if you try to grasp all the threads, at least you'll have the full picture. And you know that, okay, giving the patient options, for example, while still trying to maintain those scheduled appointments, will have certain consequences. So, okay, let's allow that, but knowing that there are such gaps, and maybe in those gaps in the schedule, the doctor can do something else so they don't feel like they're just sitting there staring at the ceiling and waiting, because their time is then simply not optimally utilized. Or maybe then some... I don't know, organize a way of scheduling appointments outwards from the middle of the day. There are plenty of possibilities, but if you only approach it from the perspective of 'the patient has a choice, by all means' and you don't take care of all the rest, then you'll probably soon have a different problem from a different source.

42:24 Radek: What you said is very important: when designing the patient journey, and now... We mentioned earlier that when facility leaders sit down to analyze the patient journey, you also need to consider how administrative pathways overlap with all of this. These pathways are also related to the staff – doctors, nurses, and so on. Because while we have a main patient journey, this journey is supported by various departments, all staffed by people. And these people also need to have their own needs well taken care of, to ensure our core patient journey remains uninterrupted.

43:04 Ewelina: Exactly. I'll share another example I heard during my studies. If I remember correctly, the hospital was probably from the Netherlands. The space was organized so that there's a corridor where patients wait, some reception area, and all staff movement, the operational kind, takes place in a completely separate corridor. This means that when, for instance, doctors move between examination rooms, or nurses walk between rooms, or equipment is being transported, it all happens in a special service corridor. This allows patients to sit and wait in peace and quiet, without that feeling of tension that something bad is happening. And hats off to whoever, already at the design stage, thought to such an extent to separate these paths and ensure patient comfort to that level. So there are many great examples out there; you just need to look for them. And perhaps by gathering examples from various places, one might find something that's optimal for their own facility, isn't excessive for current conditions, for instance, and will suffice. There really are quite a lot of inspirations, and it's worth seeking them out, especially since this topic is finally getting attention – that these facilities should prioritize the patient and should care about more than just strictly removing the disease.

44:30 Radek: So, to wrap things up, what projects or initiatives should we be keeping our fingers crossed for now?

44:38 Ewelina: Oh, I don't think I'm ready to say yet. I'd be happy to share once there's something concrete. Right now, there are quite a few challenges, and I think the ideas that have already emerged after this first month, once we implement them, will simply be great and interesting. I can only say that holistic care is something very close to my heart. And I'll be working with the team I'm with now to ensure we do more than just solve problems. And you know, on the other hand, our hospital is part of the Hasco-Lek group, so we're talking about comprehensiveness in a very broad sense here. I'm personally very excited about this, because if we're talking about an enterprise that also produces medicines and supplements, but also has a farm where, for example, these... these herbs are grown, that kind of comprehensiveness is something I hadn't even dreamed of until today, and now I'm a part of it. It really gives a huge drive to act, to approach this even more broadly and holistically than I've ever had the opportunity to before. So I'm very excited, I'm practically tapping my feet under the table, which you can't see, but I'm really happy that we have such great opportunities to act here.

46:00 Radek: Great, I'm very happy to hear that, and I'm keeping my fingers crossed. Thank you all very much for listening to this episode, and for watching too, because we finally managed to make this vision happen. So, thank you, Ewelina, and thank you, dear listeners, and I invite you to tune into our next episodes. Bye. 

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