Josep Maria Ramírez: “What we’ve learned is that the name of the injury isn't what’s important, the patient is”

A borrowed space and just one physician, Dr. Miquel Sarrias. This is how Institut Guttmann got its start in 1965 in Barcelona as the first center in Spain devoted to holistic treatment and rehabilitation of people with spinal injuries. It was a modest, unpopular project at a time when no one thought of treating these patients. The founders even went to pick patients up at their homes when necessary.

50 years later, Institut Guttmann now has a team of 433 people, cares for approximately 4,570 patients a year (according to data from 2014) and has up to 152 beds in four hospital units. In 2015, the Guttmann team celebrated their fiftieth anniversary with sights set on new milestones, including opening a new neuroclinic on the same spot where the original hospital was located, in the Barcelona neighborhood of La Sagrera.

The new center will have a clinic on the ground floor and a housing complex with 50 individual apartments on the upper floors, giving people with physical disabilities the opportunity to live independently. This new step in the Institut’s history shows how it has evolved over the past 50 years. For the first 30 years, the Institut focused on spinal injuries. In 1997, they opened the first brain damage unit and began a shift towards this specialty that continues today. Now they’re opening another new door.

Managing director of the Institut Dr. Josep M. Ramírez explains that the medical technology and techniques developed to treat brain damage are applicable in other areas of knowledge and coincide with diseases like dementia, bipolar disorder and schizophrenia, which is why the new clinic will treat conditions associated with mental health and childhood disorders. “It’s something that makes a lot of sense within our clinical line,” says Dr. Ramírez.

The neuroclinic in La Sagrera has a budget of €15 millions and is expected to be up and running in 2018, with value added: a complex of supervised apartments where a group of people with physical disabilities will share basic services, like for example nighttime personal care. According to the hospital’s managing director, this pioneering initiative aims to give patients a financially sustainable option, which is one of the main challenges they face when trying to live independently. “This is already being done in other countries, like England and Denmark, and we want to introduce this culture here.”

Dr. Ramírez believes this project fits with the social commitment of the Institut, which since it was founded –based on the ideas of Ludwig Guttmann– has applied holistic, comprehensive treatment that focuses on both the disease and the person. “What we’ve learned over this time is that the name of the injury isn't what’s important, the patient is. We work to help them define life goals, regain their self-esteem and independence, and take the reins of their life again.”

Of all the initiatives in which Institut Guttmann collaborates, they highlight the d·HEALTH Barcelona program. The fellows in this Masters of biodesign course do an eight-week stay at the hospital to identify unmet healthcare needs and find a way to address them that can also be a business opportunity.

The challenge of neurology

The rehabilitation methods used at Institut Guttmann have been revolutionary, with sports and physical activity playing a key role. “We help patients discover what they can do, instead of subjecting them to what they can’t, in order to push them to be independent,” explains Dr. Josep Maria Ramírez.

Now the Institut has set a new goal and wants to tackle the great challenge of neurology: restoring patients’ injuries and recovering functions from before the accident. The Institut is working on several neurological techniques to help reestablish the brain circuits with procedures from pharmacology, non-invasive electrical stimulation and ICT elements with computers and passive robotics.

“A spinal injury or brain damage can be restored when the brain identifies the circuit that has been damaged and finds other cells to carry out this function,” explains Ramírez. The managing director explains that they are using several highly specialized, intensive techniques, like for example the combination of stem cells and electrical stimulation to restore spinal function, but that scientific proof is needed. “We’re working with other centers, commissioned by the WHO, to prove that these methods work and to segment them by type of patient.”

Financial health

Since it was created, the Institut has reinvented itself after two crises. The first was a result of the decrease in accidents and spinal injuries, as the number of patients dropped 70% in 10 years. The second, the financial crisis and healthcare cutbacks.

Dr. Ramírez explains that they have taken two measures to address these changes. First of all, the hospital began to internationalize, attracting private patients from abroad (they currently receive approximately 60 each year). And, secondly, they made the decision (agreed upon and accepted by the workers) to take a voluntary pay cut in order to avoid layoffs. “These two measures have meant that we’ve always been in the black and haven’t had to cut any innovation and quality programs.” This is why the managing director says Institut Guttmann’s 50 years of history are down to the commitment and hard work of everyone who works there.