TSVETELINA SPIRIDONOVA, MD, PHD: IN THE NAME OF THE PATIENT

When Tsvetelina Spiridonova, MD, PhD, took over Higia Hospital in early 2019, she had big shoes to fill. Established in 1991 by her father, Professor Stayko Spiridonov, as the first private hospital not only in post-Communist Bulgaria, but also Eastern Europe, Higia was widely respected for the quality of its treatment. Dr Spiridonova was more than prepared for the responsibility to continue pushing forward Higia's brand. A surgeon, she has specialised in France and is an honorary member of the Bulgarian Surgeon Society and a member of the German Surgical Society and the French Association for Plastic, Reconstructive and Aesthetic Surgery (ЅОFСЕР). Dr Spiridonova has also graduated healthcare management and is fluent in the organisation and life of Higia hospital, where she has worked for over a decade.

However, soon after Dr Spiridonova took over the management of Higia, she faced an unexpected challenge: the outbreak of the Covid-19 pandemic. In mere days she and her team reorganised the hospital's work to make sure that it would continue to run as flawlessly and efficiently as before. Dr Spiridonova and her team managed the crisis in an impeccable way, defending the reputation of Higia and winning new friends and grateful patients. In the end of 2021 Dr Spiridonova was deservedly awarded the Frontline Manager award by the Confederation of Employers and Industrialists of Bulgaria. This April she will also receive the grand prize Entrepreneur of the Year 2020-2021 given by the Association of Entrepreneurs in Pazardzhik.

We met her to learn more about how one can provide excellent healthcare in Bulgaria.

Dr Spiridonova, according to optimistic prognoses the Covid-19 pandemic is almost over. What is your recapitulation for the past two years?

Elon Musk is an amazing visionary. If our societies do not realise that we need a radically different approach towards climate and the Earth's flora and fauna, and if we do not stop threatening one another with a nuclear war, we will soon be forced to leave the planet altogether. The pandemic demonstrated the power of the invisible world to rearrange our world and its rules. To enforce restrictions on us.

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In the healthcare field, the recapitulation is that there is no such thing as an unnecessary investment when providing healthcare and preparation of healthcare facilities are concerned. In reality, hospitals are a part of the state's national security system. A visionary long-term policy in this respect will make sure that the healthcare field is provided with both the legal frame and the investments needed for it to be an efficient barrier against the next pandemics to come and as a way to preserve human resources.

What were the biggest challenges that Higia Hospital faced in this period?

The challenges were linked mainly to the staff's management and motivation. I do not know if the general public realises it, but in hospitals all over the world the Covid-19 units were staffed by doctors who have never thought of dealing with infectious diseases: ophthalmologists, surgeons, obstetricians. They had to be convinced of this change and consent unconditionally in mere hours. It was like making a pilot to switch to flying a spaceship or driving a tractor the next day.

The second challenge was about the needed structural and organisational changes and financial investments during an extraordinary situation. They, too, had to take place in a couple of days: restructuring of hospital units, opening of isolated entrances, oxygen installations, securing and providing PPE and disinfectants. This asked for a significant financial resource, and it was not clear whether it would be ever reimbursed and how. But it had to be done anyway, in the name of the patient. In the end, the government partially compensated our financial expenses.

In late 2021 the Confederation of Employers and Industrialists of Bulgaria awarded you the Frontline Manager prize. What does this award mean to you?

The Confederation of Employers and Industrialists of Bulgaria is this nation's most renowned employers' organisation. It is a real pleasure to learn that the big business values the work of doctors and recognises the stress experienced by healthcare managers who have to run the system in order for it to operate swiftly and efficiently. With this award the Confederation established the rule that true big business is possible only when you have preserved your humanity.

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Higia Hospital cdelebrated its 30th anniversary in 2021, the first facility of its kind in Bulgaria and Eastern Europe. What does it feel to be a healthcare trailblazer?

Thirty years are a good age for everything – whiskey, love, career and making recapitulations. The hospital became a trailblazer thanks to its creator, my father Professor Stayko Spiridonov. A very good man who mortgaged the family flat to invest, for the first time in Eastern Europe, in a small hospital with 5 offices and a surgery room. But, as a popular Bulgarian song says, when a decent human being supports another decent human being good things happen. Professor Spiridonov had people like that in his team, people who believed in his idea. Until today, people do not leave his team. Instead, they grow in it to become true stars. Birds of a feather always flock together.

How did Higia Hospital evolve in time and how do you meet the changing trends?

As someone who has worked for years in Paris, my concept was to bring European good practices to Higia in a number of ways. The end goal was to turn Higia into a model for complex and quality healthcare. The colleagues at the hospital sensed both the new dynamics and the raised standards, and adopted them seamlessly. Under European good practices I mean that the approach and honesty towards the patient should be crucial in the hospital's work. They are not the first priority, but should come before the second one. So today, we have put professionalism as our leading principle, followed by commitment to our patients and backed up by the top class technology in our hospitals. Full dedication to medicine is the main criteria that we follow when hiring staff at Higia healthcare facilities, both for doctors and nurses.

Surgery is a field dominated by men. What motivated you to dedicate yourself to this part of medicine?

Nowadays this outdated understanding persists only in Bulgaria and other former East bloc countries. The broader world has long realised that women can be stellar surgeons: precise, self-critical, uncompromising in each gesture.

What qualities should one possess to be simultaneously a dedicated doctor and a good healthcare manager?

You need to be taught to never give up. To take the turn even when you are driving too fast. To be brave enough to risk when you are convinced that you are right. To be somewhat stubborn.

Besides your memberships in prestigious professional organisations in Bulgaria and abroad, you are also a member of the Managing Board of the Bulgarian Hospital Association. How does the organisation help to improve Bulgaria's healthcare system?

The good manager knows that the hospital is actually the doctors and nurses who work in it. However, a well functioning hospital is made of organised, motivated and carefully selected teams. The Bulgarian Hospital Association unites hospitals as functioning structures, which in the context of a generally underfunded healthcare system actually provide effective and efficient healthcare. Doctors and nurses can provide quality healthcare only when they work in adequate conditions and are supplied with proper equipment. This is why the Bulgarian Hospital Association insists on having representatives of the healthcare managers in the advisory boards of the Healthcare Ministry, the National Health Insurance Fund and the Bulgarian Medical Association. These people know what it costs them to preserve the motivation of doctors' teams through financial crises, inflation and pandemics, and to have fully functioning hospitals supplied with enough medicines.

What good practices can be borrowed from Western healthcare systems and in which fields?

It should be clear that no healthcare system in the world is ideal and unconditionally approved by the people it serves. I have always said that Bulgarian healthcare is not as bad as patients believe it is. Its most important advantage is its accessibility. Compared to the other countries where I have worked, only in Bulgaria you can book a consultation with a leading specialist in 3-4 days, and the examination will be either covered by the National Health Insurance Fund, or will cost less than a dinner in a mid-range restaurant.

What we can borrow from Western Europe is mainly in the connection between the three sectors of the healthcare system: GPs, outpatient clinics and hospitals. Unfortunately, when Bulgarian patients leave one of the sectors they are not aware how to continue their treatment on the next level.

The second crucial component that will guarantee a high success-rate and improved respect towards everyone in the Healthcare Ministry is securing the emergency aid system for all regions in Bulgaria. Perhaps the right policy will be to not turn dysfunctional hospitals into outpatient clinics, but into ER departments with ambulatory sectors instead. They should provide transportation of patients to proper hospitals where they can get the treatment they need, in 24 hours.

How do you win the trust of your patients? What does a fully-functioning connection between doctor and patient look like?

I talk to them. I try to understand what they expect and I am honest of what I am capable to give them. I have always had only very good people for patients. This is incredible luck.