Montserrat Figuerola: “Primary Care is in a magnificent position to generate knowledge”

The President of the Board of Directors of the ICS speaks about the current challenges of the institution, the fundamental role of Primary Care and the importance of research to improve people's health

Montserrat Figuerola Batista has been the President of the Board of Directors of the Catalan Institute of Health (ICS) since September 2024. With extensive experience in public health management, she has held several positions of responsibility at the ICS, including Director of Healthcare Services and Territorial Manager of the Southern Metropolitan Area, among others. Committed to innovation, sustainability, and continuous improvement of the healthcare system, Figuerola has also promoted leadership and equal opportunity initiatives within the organization. In this interview, she talks about the current challenges of the ICS, the fundamental role of Primary Care, and the importance of research in generating knowledge for improving the healthcare system.

In September 2024, you were appointed President of the Board of Directors of the ICS. How have these first months in the position been?

We have a broad Board of Directors, with representation of several departments within the Generalitat (Catalan Government), the local community, professionals, social organizations, and patient organizations, to whom we rely for accountability and to develop strategies on the institution’s key issues. With Dr. Pomar, Managing Director of the ICS, we agreed to focus the summary of actions and results on five strategic pillars: the company’s focus on patient satisfaction and their shared responsibility in everything related to their health; the development of professionals through their skills development and the strengthening of team leadership; the provision of quality, responsive services geared toward continuity of care; innovation and everything related to knowledge and research, and sustainability, both in resource management and in the impact on the environment. In all of this, a fundamental aspect is promoting professional participation.

Most of your professional career has been linked to the ICS. What is your vision of the institution and its evolution?

It is a living institution, constantly evolving and capable of transformation, with a very service-oriented vision. Over the last twenty years, it has significantly improved its transparency, both internally and externally, well aligned with the policies of the Department of Health and CatSalut.

What are the main challenges facing the ICS today, considering technological and social changes?

We are very focused on transformation, innovation, and leadership to achieve motivated and service-oriented teams. We have high expectations for the CAIROS [Committee for Evaluation, Innovation, Operational Reform of the Health System] of the Department of Health, which is based on modelling experiences that focus on key aspects for improving services (maximizing professional skills, strengthening clinical leadership, management autonomy, tools to support clinical decisions, debureaucratization, results-based recognition models, etc.), based on the contributions of professionals. The objective is to provide an evaluation of the models deployed to improve the care we provide to the population.

What is the role of Primary Care in our healthcare model and, specifically, in the ICS (Institutional Health System), which manages 75% of primary care teams?

It plays a fundamental role. Primary Care is not just a level of care, but an element of integration. Therefore, it is important to provide it with tools to ensure continuity of care, relationships with other levels of care, and accessibility. This is an issue that concerns us; our priority is to improve accessibility and resolution.

How do you imagine primary care in Catalonia in ten years?

Looking back, primary care has improved significantly in recent years: in resolution, quality of care, and proximity. Especially, after the pandemic and with the strengthening of online visits, there has been an increase in demand, compounded by the rise in aging –with the increase in chronicity, complex pathologies, and risk factor management– a growing population, and new societal habits. Primary care has expanded its service portfolio and increased resources, but these are still insufficient.

If primary care can improve its relationship with the other levels of care, it can become the true manager of patients in the public system. I am referring to transversality, to the management of patients’ journeys through the system, considering the levels of resolution, support, and coordination with home care and social care.

In ten years, I believe that Primary Care will be more managerial and coordinating, more social, and more decisive.

We have just commemorated the centenary of the birth of Jordi Gol i Gurina, after whom IDIAP is named and who greatly influenced the reform of primary care and the development of family medicine. How do you think his legacy continues to inspire primary care?

I think it is very much so. One of Jordi Gol’s contributions was his service-oriented approach, focused on the patient. The concept that being fair doesn’t mean giving everyone the same thing, but rather what they need. That’s why it’s necessary to assess people’s needs.

Focusing on the clinical aspect is a factor that excites professionals, who want to be recognized for their work in improving people’s health, not for whether they have made more or fewer visits.

Furthermore, Dr. Gol i Gurina was convinced of the need for multidisciplinarity, and in recent years we have incorporated new professional profiles into Primary Care, who are integrated into the teams: psychologists, physiotherapists… A key profile is that of healthcare administrators, with skills that facilitate healthcare activities.

What role does research play in Primary Care?

It is very important, as demonstrated by the work carried out by IDIAPJGol. Primary Care is in an excellent position to generate knowledge based on the management of patient needs. All the knowledge derived from the healthcare sector, the community sector, and all aspects of innovation and technologies such as artificial intelligence. We must continue investing in and providing more resources for the generation of knowledge through evidence.

What challenges does the transfer of research results into clinical practice pose?

Too often, we conduct research, obtain good results, and then struggle to transfer them. We need to strengthen public-private collaboration and strengthen negotiating capacity through mutual recognition. For us, recognizing the knowledge of professionals is a key element.

One challenge we face now is how to connect the information collected by the devices we use to measure health indicators to the medical record: diabetes monitoring systems, smartphones… The integration of technologies is important to prevent good solutions for specific problems from becoming a source of disintegration for our system. Leadership is also very important. Making important changes requires good leadership. I am convinced that change lies with professionals and their leaders.

You are someone who places great importance on values, which you have emphasized many times in your speeches. What values ​​do you think should guide the ICS and health research?

The values ​​of the ICS –competence, participation, commitment, equity, innovation, and transparency–, and the ones of IDIAP –sensitivity, rigor, and creativity. A fundamental value is respect and trust in professionals and their scientific capacity, endorsed by the institutions responsible for conducting research. Also, equity and the awareness of public service must govern the processing of anonymous data that will be a source of knowledge and that belongs to the patients of our universal public health system. This is a great added value of our healthcare system.

Since your retirement in 2023, she has been a mentor for the ICS Women’s Leadership Program. What activities does this program carry out?

This project was created to promote equal opportunities between men and women in the institution. Three out of four professionals at the ICS are women, but their representation is much lower when we reach the levels of department head and clinical director. This equal opportunity must be achieved through developing leadership capacity, not through quotas.

You asked earlier about values. To achieve this leadership, it’s essential to start with values. Go beyond the curriculum and the professional career and consider the values, skills, and abilities of individuals: team vision, desire to grow people, fostering collaboration, and building projects through teams. These are the characteristics of feminine leadership, which is not exclusive to women.

Only by working with people will we be more transformative, and in this regard, clarity of objectives, respect, and those aspects we take for granted and aren’t always addressed are important: talking to professionals, welcoming them, ensuring they know what is expected of them, and assessing the deployment of their team responsibility.