Welcome And Show Mission

Dr Andrew Greenland 0:00

Welcome to Voices in Health and Wellness. This is the podcast for doctors, dentists, clinic owners, and healthcare leaders who want to build smarter, more sustainable business models without losing clinical integrity. Most healthcare podcasts focus on clinical updates. This one is different. Here we talk about the operational realities, patient expectations, scaling challenges, leadership decisions, and the models that actually work in today's complex healthcare landscape. Today I'm joined by Dr. Michael Averbukh, CEO and managing partner at Serenity, based in Lisbon, Portugal. Michael brings over 25 years of experience in healthcare leadership, combining clinical expertise with high-level operational and strategic management. At Serenity, he's building something genuinely distinctive, a high-touch health case management model where every member is assigned a dedicated nurse who acts as their advocate and navigator through an often fragmented and overwhelming medical system. With that, Mike, I'd like to welcome you to the show and thank you very much for joining us.

Dr Michael Averbukh 0:58

Thank you very much for having me. My pleasure.

Dr Andrew Greenland 1:01

Thank you. So you've had a long career in hospital and healthcare leadership. What led you to build a health case management model rather than another traditional clinic?

Dr Michael Averbukh 1:17

My story is that. As you mentioned, sorry. And every time I came across this uh reality and some remarks from my uh colleagues, they always told me the same. So you always preach about evidence-based medicine and technology and the newest publications and uh search for the for the newest possible treatment protocol, etc. etc. And yet, each and every time that we bring that, you tell us, did you talk deeply and and thoroughly and for a long time with your client? Did you listen to them? So what is it that you want? And at the end of the day, I I kind of I created for myself this image of myself in my head. Every time that I look in the mirror, I see a physician that really appreciates all the knowledge and all the new advancement because you can't go without that. But if I could, I would really put everything in this old-fashioned doctor's bag, you know. The old ones, the leather ones that you brought with you to a family that you visited. If we could create this world that combined those two, that would be wonderful. And on the personal side, maybe this is what brought me to where we are today. Joining me in Serenity uh some years back was my business partner, Rita. Uh she's a Portuguese, she comes from a background of client experience, and at the end of the day, she she was part of my management team in the last hospital I worked. Um we both believe that each and every person actually deserves to get access to the best possible advocacy, to the best possible support, to the best possible literacy about what's going on in their medical clinical life, in their medical journey. And nowadays, when uh clinical treatment, when medicine is so much fragmented, so much information around, so many specialties and sub-specialties, etc. etc. etc., people lose this touch. And we believe then, and we believe today even more that if we combine everything, everything in a working model in which people can be supported by medical professionals every step of the way, every day of their life, every opportunity that they have, every obstacle they come across, or every doubt they have. If people have this support, if they have an available person that knows them well and can assist them, can hand hand, can land hand, sorry, can provide an advice or just uh a sympathetic word that would drive their medical journey towards uh better outcomes in each and every encounter and each and every meeting with a physician, with each and every occasion in which they have to read through their medical tests, the lab tests, or the imaging that they just received, and they don't know what they're reading. So this what actually led us to create the current model in which there's a case management, there's a management process of one's clinical needs, and it is done by medical professionals, so it is really managed rather than coordinated schedule, appointment scheduling or whatever, agenda managing, uh with a very, very personal touch, with a deep personal acquaintance of the case manager of a nurse case manager in our case with a client. And that was a very long explanation to a very short question that you had. I hope, I hope I I managed to to uh to deliver the message.

The Real Cost Of Fragmentation

Dr Andrew Greenland 6:38

Very helpful to hear a little bit about your background and the context for all of this. And I guess I'm just curious to know, was there this is all about really navigation, and I just wondered whether there was a particular point when you realized that navigation was really the issue for many people rather than the treatment itself. Was there a particular case or was it a repeated patient experiences, or was it from the operational experience from working in healthcare systems?

Dr Michael Averbukh 7:03

It's all in a way taken together. You know, I I see I have seen through my life, and even today, when we work on a daily basis, uh, patients or clients, it's not necessarily a patient with a disease, right? It's a person that has an issue, that has a question, that has symptoms, that is ongoing through some kind of an investigation, or actually just following his screening routine. And they are constantly being sent to repetitive tests by different specialties. They are many times sent to repetitive imaging uh uh exams just because, because one sends to, I don't know what, a chest CT, and the other one wants the same CT but with some specifics, whatever. What why not doing one CT only? Or an MRI or an ultrasound or blood tests? Why going back and forth to the lab because a physician A asked you for a set of blood tests that started at A and end up at I don't know what D, and the other one three days later, asked uh whatever, L to P exams. And you go twice to the lab and you're and you're being stabbed twice, and your insurer pays twice, and and so on and so forth. We see it repetitively. We see it because, and this is an inevitable in in this in a in some points, because medicine and medical knowledge became so extensive and so uh uh focused on a narrow specialty that some uh specialists work in silos. I am a specialist only for surgeries of my of the left palm of the hand, and the other one is the right palm of the hand, and sometimes, too many times actually, nobody overlooks uh the process. Nobody looks at the bigger picture. And you can make this whole process more efficient, more effective, uh less uh less friction through through it, less money spent, less time spent in vain. And all you have to do is manage the process. This is it.

The Nurse-Led Client Journey

Dr Andrew Greenland 9:49

Fantastic. So let's break this model down um clearly for our listeners. And uh you've mentioned just now the dedicated nurse case manager. What does this mean if we take a I don't know, a patient arriving with a complex medical condition? Talk us through the journey, how it actually looks, just so our listeners can really understand the nitty-gritty of this process.

Dr Michael Averbukh 10:10

So uh actually, it can be a patient with a complex medical condition or or not at all, just somebody who is uh concerned and and seeking for a good well-being process, no. Uh but each and every client of ours goes through in in a way an onboarding uh um uh process through one to two meetings, normally online with a nurse case manager, in which we focus according to one's uh uh priorities and and you know, more burning issues or more uh perceived urgent uh tasks on behalf of the client. We do focus on two major aspects. One, who is the person as a person? How do they like to be addressed? What is the communication plan that we can create for them? How do they want to be contacted? WhatsApps, mails, phones, whatever, a bit of a family situation, where do they live, who supports them, and so on and so forth, a bit of a family background. And the other one is naturally the clinical intake. This is one we understand from this first encounter uh what are our urgent tasks. They could be, as you mentioned, uh very high priority uh deeds that we need to perform immediately because a client of ours has an ongoing, very serious clinical situation. We can't rest even for a minute, and we have to arrange for him all the set of diagnostic procedures or treatment and so on and so forth. It can be somebody that there's no nothing urgent, but there is a bunch of planned acts that we have to do and take through next months or a year. From that point on, your case manager becomes your go-to person in whatever happens. Uh, whatever was an annual plan, in our case, normally an annual plan is being executed by your nurse case manager, meaning we would schedule for you all planned interactions with the medical world. Uh, notify you and prepare you for anything that is coming up. Prepare you, meaning when you go to your annual exam, please do not forget that these are the uh uh the specific points that you have to mention to your physician if he didn't remember. Please ask for this and for that, please renew your prescriptions and so on and so forth. Right. We always ask for a feedback after an interaction because many patients, and I've seen that in my life, and you see it probably every day, they come to you as you as their physician, they talk to you for half an hour, 20 minutes, one hour, whatever. They walk out of the door. Sometimes before the they open the door and say, Ah, and doctor, I forgot something, and this something that they forgot was the main thing that brought them. Or they already walked out of the door, close the door, and then they remember that they forgot something. So we prepare our clients not to forget and focus on what's important. When they walk out of the door, they give us the feedback of what went there, uh, what's the plan, what are the prescriptions, what's next, who is following up with the exams that they were prescribed, and so on and so forth. And this is what actually happens on each and every encounter of our client with the medical warrior. Now, on top of that, when something comes up as an unexpected uh uh event, new symptoms, uh an urgency, whatever, your case manager or our client's case manager is the go-to person. They are one phone call, one email away from from somebody who knows them. And this uh um acquaintance, this uh personal touch makes a whole difference, a whole world of difference in the way that our clients can count with us each and every time something happens, and in the way that their case manager, nurse case manager, can address their urgent or whatever issue because we know our members not only as a clinical case but as a person, and this is uh a major difference, it creates a major difference in how they open towards us, on one hand, and a major difference in our ability to provide care that is beyond just answering the pure clinical layer of their complaint because we understand not only the clinical complaint, we understand who is the person behind the clinical concern. And this many, many, many times means uh uh a whole different world for us.

Preparing Clients For Appointments

Dr Andrew Greenland 15:55

Thank you. That makes things very, very clear, and I like your know the know your client philosophy. I think that's fantastic. So, do your clients come to you already plugged into um medical services elsewhere, or people, uh physicians, clinicians, everything elsewhere, or do they come in and you're basically starting from scratch, you're basically organizing and managing their case when they arrive? How does it work for those patients?

Dr Michael Averbukh 16:21

It's a it's a mixture, it's a it's a full mixture. Some patients would come again, patients, clients, members would come to us and say, Look, I I really need your assistance in general or in a particular situation, but I have a great GP and I have a great uh gynecologist or cardiologist with whom I'm very much okay for the past years. So we're not overstepping anyone, we're not trying to uh to switch providers. We would normally go with, not normally, always actually, would go with what works best for our client. And if the client has a great relationship with a treating physician, be it whoever it is, we will never change it, we will just assist in the management of all the rest. It is important to say that within this working uh uh model, we are not uh overriding anything that already works. We just a complementary uh service to what uh people have if what they have works for them. We as well do not refer our clients to practically preferred providers, we don't have any commercial agreement or commercial drive towards preferred providers, not by financial, not because of financial reasons and not because of anything else. We seek and find the best uh possible suit for each and every client's complaint or need or symptom. We will always look for, all right, so you, as my client, have now X and Y and Z, and we understand that our working diagnosis is this, and our plan is that, and we will always look for what suits you best in this particular situation of your clinical complaint right now with the place you live in, with yes or no insurance coverage and so on and so forth. But we will never say, oh, so look, anyway, we have a great uh agreement, commercial agreement with hospital A, so we'll send you there. It does not exist. And actually, we're very proud of that, that we are not connected commercially to any provider. Any provider can become a provider if he suits the specific need of a client at a particular moment.

Working Alongside Existing Doctors

Dr Andrew Greenland 19:17

Thank you for clarifying. So you've chosen nurses as your core relationship anchor. What was the thinking behind that? I mean, could it have been another kind of clinician or would have an MD been preferable? What was the thinking behind using nurses?

Dr Michael Averbukh 19:32

A couple of things. I think that uh doctors can't work without nurses. This is my perception. Why uh one. Two, I believe that nurses uh possess the right clinical knowledge to assess a patient, a client, a member, at each and every point. This is what they do in hospitals and clinics. They do the first triage, the first interaction between a client and a medical facility would normally be through a nurse. I think that nurses are as well much better prepared and ready to provide the needed portion of uh sympathy and empathy, many times more than physicians. Their availability to uh to sit and talk to a client in that case, um mentally is a bit bigger, higher, wider than the ones that MD possess, uh and it works. So we needed somebody with the right attitude uh but with the right uh clinical knowledge, and I found nurses to be the ones.

Dr Andrew Greenland 21:05

Great. How do you maintain quality control when you're referring to external providers? Because you are essentially, I guess, like a hub and spoke model. You're sitting at the center and you're referring people out for various things. How do you get that quality control?

Why Nurses Anchor The Relationship

Dr Michael Averbukh 21:20

It's a great question, actually. So, first of all, we uh we really tightly vet uh all the people that we refer to, with or without their knowledge, by the way, uh, through uh peers referrals and what they say, etc. etc. Um, and trying to understand uh from an objective perspective who is this person. Actually, objective can be CVs and then and clinical background, subspecialties, uh uh so on and so forth, where where the physician was. Trained, uh any kind of fellowships, you know. But I think that the core of the quality rating that we internally created is understanding what were the decisions made with our client. Uh in the world that we work in, meaning Portugal, we work as well in Spain and uh uh recently in the UK, uh we had very little, very little, if any, uh reservations with clinical decisions, because the training of the physician and and their knowledge and and the fact that they are updated is practically at a very high level. But what we pay attention much more than the pure clinical decision-making process is the experience that our clients had with a physician. And when I say experience, it's not necessarily like how was your interaction with the with a physician? Oh, it was great, it's not there. We're asking very specific questions that, and this is part of our methodology, that allow us to understand did this specific doctor uh deliver the expected pack of experience? I mean, yes, he was clinically right, and and he really did what is needed and what is necessary, but as an example, did he take the time to make the client part of the decision-making process? Did he explain? Did our member feel that the doctor really listened and understood what was the what the complaint was, or what brought our client to this position, rather than oh, so what's your name? Yes, I'm in a computer, etc., etc. Here are your prescriptions by. And we we have an internal uh methodology of what the feedback that we uh get back from our clients, and we have as well an internal rating. According to the internal rating of physicians to whom we refer, we refer the next client or not, by the way. Um now, everything on, as I said before, this is a major part. We we we really see uh great uh importance in this feedback. Everything that is clinical that is not very well straightforward. We always ask uh our it's not exactly a formal board of advisors, but we have a group of uh well known and and and uh well-trusted by us advisors on many uh clinical fields. So I we can always go and check back like wait, this sounds to us a bit different than what we thought. What do you think? And again, it happened really less than than a palm of the hand times that we said, wait, this doesn't sound okay, and and it wasn't okay. Like, you know, the clinical uh decisions or the clinical recommendations that uh somebody did. Gladly we we weren't there.

Dr Andrew Greenland 26:02

So you have a obviously providing a very, very personal service. Just curious to know what operational systems you have to support this high level of personalization.

Dr Michael Averbukh 26:13

Um several things. Let's start with the people that we recruit to work with us. Actually, uh, you know, it's it's it's an interesting story. When we started, we started with two nurses and a bit of the mean people, and uh, five years later into the game, we are 23 people on the staff. So we grew. And I'm happy to say that we uh recruited well. Uh and the recruitment as well goes naturally, it's somebody with with a uh proper medical background, but it's mainly who the person is, because as I said before, this is what matters to us uh a lot. Uh, this is one. Two, um, how do we train our people and how do we maintain uh consistency in what we provide? Also, a very interesting process that uh we witnessed and and made a lot of errors in the middle, but witnessed and and grew and and matured into something that we are pretty proud of. Um we created even an internal book of wisdom, uh, which is not uh the normal operational set of what to do, but rather a uh a set of how to think, you know, a methodology that we built internally. There is naturally an internal feedback process on a weekly basis, uh, analysis of ongoing cases, etc., etc., internally inside the nurse case management team, uh on a wider extent with our in-house GPs and consultants. Ums technology, we have a uh tailor made for us, CRM. We are using naturally a uh simple, not too sophisticated but necessary uh EMR system. But I think that what assists us assists us most in the process are the uh nature of people. And as I said before, the very, very much tailor-made with a lot of perks and and uh and uh uh adaptations to the CRM that uh that we created for ourselves. It is still not enough. I mean we're we're happy, but we're not very happy, or you know what? I'll rephrase it. We are happy, but we're not totally satisfied with what we have in hand. Uh so we are working on creating uh something that would be our own uh serenities platform that would improve our ability to uh bring into the circle of treatment and uh information sharing as well, not only case managers, but to bring the client himself into the close circle of uh being exposed to information, naturally information that the client can be exposed to, ability to make treating physicians part of the circle. Uh so we're working on a technology solution. This will normally probably take time. Uh, but the idea is to build a platform over an app that would allow us much faster interaction with the with our members and with their uh treating physicians. But again, this is a bit of a future.

Dr Andrew Greenland 30:20

Thank you. So do you see Serenity as a healthcare provider or as a healthcare integrator, or perhaps both?

Systems Behind High-Touch Care

Dr Michael Averbukh 30:28

I don't see I don't see us as true provider, although we do have uh provision of primary care in-house for for clients that choose to do it uh with us. It's it's faster, it's easier, it's much more efficient, but naturally not all of the clients because we work across all Portugal, for example, across Spain, uh in the UK, not everyone that that wants to work with us would uh take a train or a subway or whatever, take a drive in Portugal of an hour or two to get to a primary care physician in-house. Uh so I wouldn't call ourselves a provider. Again, we do provide care. I don't think we are a healthcare provider, and as I said before, we don't want to step on anyone's toes, and we don't want to change things that work, we're good. Coordinators, maybe I would uh call ourselves um the health journey managers, case managers. I think that's that that's that's a good definition. Uh and in a in a like we're tagged as a medical concierge service. So, yes, it is a medical concierge service, but it is much more than the common uh known uh model of scheduling or speeding up your uh uh consultation or appointment. It is literally managing your healthcare in a much better efficient way. Scheduling and speeding up appointments is part of it according to a preset clinical urgency, according to our understanding of whom we're talking with. Um so that's that would be it.

Dr Andrew Greenland 32:31

Thank you. So thinking about the model, um, let's talk about who this works best for. And I know that um the model has strongly resonated with expats in Portugal. What specific friction points are you solving for them?

Dr Michael Averbukh 32:46

First of all, yeah, it's it's it's important. Thank you for for mentioning that. In Portugal, our main clientele are expats. Uh, but it's not the same, for example, in the United Kingdom, but here with expats. Uh what brings them to us is the knowledge uh that they should be taking care of their well-being, but this is a common knowledge. Uh, but a common pain, common reason even to look for our service is the fact that expatriates come across a system they aren't acquainted with. Uh they are foreigners in a country, they don't speak the language, they don't uh understand the culture, and they don't understand the system. And that was the first obvious obstacle that uh expatriates came across in Portugal and they were seeking for a solution, and we came in in a way that was the reason that we even started addressing mainly uh expatriates. By the way, happily we're having more and more local clientele as well, because they suddenly started to understand that language and understanding the system, even if you possess those virtues, it's not enough. And this is exactly what uh we understood that could work in places in which language and culture aren't a barrier. UK, right? The system there, everybody speaks English, right? The system has its own particularities, NHS, private, etc., etc. referrals, yes, referrals. No, you know it better than I do. And yet uh this fragmentation of services uh and the uh the asset of time that not everyone possesses with an unlimit in an unlimited way, uh creates an opportunity for us to be uh in such a market as well. Just again, managing better your journey with within a system that you theoretically know very well and no language barriers there.

Solving Expat And Local Friction

Dr Andrew Greenland 35:06

Thank you for clarifying. And I know um you talked about London as being somewhere you're expanding into. What's going to be different and what's gonna be the same about moving to London compared to Portugal?

Dr Michael Averbukh 35:19

Oh uh same methodology. This is uh this is happily uh the easy part of expenditure. I think that the method proven to be working very, very well. So we are not going to change the method in which we approach a potential client and in or the way that we treat uh our members. The difference uh is in the type of clients and in the pain that we will be solving. Uh, as I said before, uh in Portugal, the main reason that people come to us, the vast majority of our clients, is look, help me with the system. I just don't understand what I have to do. And when I try to do something, it's a language, and I don't understand how it all works, etc., etc. I think that in uh London the the main issue is that uh people just don't have time enough, they do not understand not how the system works, but they really don't understand the tiny bits and and um and small moving parts in order to get to the best possible solution for their problem. And uh we should be there for them because this this is actually you know London in a way is a better example of why we should exist, uh highly populated in terms of uh providers, highly populated city, you can find everything you really want, everything, right? In several big private networks of providers, clinics, all across the city, NHS or not NHS, you want NHS, you go to NHS, with all the problems of NHS. You want private, it's everywhere, you want everything on a single street, you go to Harley. Everything is is is there. You just reach and touch it, and yet who do you choose? Who is the best in class in a certain uh specialty? Who is the best in class for me? There's so many. But it's for sure not a bad one. Uh where do I go? Now, who do I ask? Uh so if you have somebody that again, you can ask Chat GPT, by the way, or you can ask Dr. Google, right? But this is the whole idea. If you have someone like us, like Serenity, whom you trust, with whom you created a relationship, the nurse that already helped you several times, and she knows you, and whatever, she is your friend. She is your helping hand calling and saying, Hey, I have this issue now. Please help me. And by the way, we will always be transparent and we'll say, you know what? Look, in this specific area, I personally, as your nurse case manager, I don't have any anyone, I don't do not have anyone that is on the top of my list immediately. But let me do my research. It will take me two days, I'll come back to you. And this research is exactly what I uh spoke about before. We will do the whole vetting system and we will ask all the connections that we already have, even in the UK, to point us towards the very right person to our client whom we know. And then the nurse case manager will call and say, Look, I know that you prefer uh doctors that would really sit with you for an hour and explain everything to the detail. And I know that in your specific condition you would prefer a female surgeon, whatever. And this is why I chose Professor Something. But this is not only because this Professor Something is the best uh uh uh doctor in-house for your specific problem, because she's very, very good, and she's a female surgeon because this is what I know you prefer, and she takes the time with her clients to explain everything to the beaten bite, and I know that this is important to you. And that would be a totally different choice if I had a client that said, Look, I trust the medical system completely. Whatever you tell me, I don't need explanation. Just tell me a name, and I don't need this doctor to talk to me at all. I don't like people that talk to me and explain everything. I get stressed. I just want him to put me on a on a on an OR table, fix me, and I walk home. Same clinical problem with a totally different referral to a totally different physician.

Dr Andrew Greenland 41:02

Got it. So, in a sense, this is a a premium convenience product because you're removing the overwhelm and you're maintaining this high level of um personalization for somebody like a busy executive who has no time on their hands to give them the very best without them having to work through this themselves.

Dr Michael Averbukh 41:18

Yep. It is a premium product, yes.

Why London Needs Navigation

Dr Andrew Greenland 41:25

So obviously, you talked about the um Portugal operation, you talked about moving into London. Um, you are running a business at the end of the day. What are the things that are going particularly well from a business point of view in Serenity?

Dr Michael Averbukh 41:39

Uh, you know, business always can be better. Uh, but I'll I'll tell you from a business perspective what we are very, very proud of, and I hope that we will maintain uh this specific area to be proud of for uh for any place we will step in the future. Uh more than 92-93 percent of our new clients are clients that uh are referred by happy other clients. I think that this uh uh symbolizes a lot. I mean we we are not uh investing on social media publicity, whatever. We're not uh we're not making a lot of noise. Uh and in a business uh that is basing itself on a returning clientele, on memberships and renewals, but the fact that new clients come to us because somebody referred them is a great achievement. So I think that this aspect of the business is is something that we are particularly um happy with and proud of, and that would be it if you asked me to point out one successful piece of our business.

Dr Andrew Greenland 43:11

That's amazing. That's a very, very good um statistic to share. Thank you. Um, and on the other side of the coin, what are the challenges or bottlenecks that are most impactful for you right now in the business?

Dr Michael Averbukh 43:22

There are so many. Everywhere. Portugal uh always. Uh UK bureaucracy is something new for us, but we're we're there, you have to, right? Uh bureaucracy for sure. I uh believe that uh in Portugal in particular, and and then to a certain extent in the UK, because we're a new business. Um financial support, I mean, financial support uh has its own angles, but uh You know, uh, institutions, banks, or or whoever else that is supposed to encourage new businesses uh is a big lacoon in Portugal, unfortunately. I didn't know that when we started, actually, and that was a big disappointment for me, and it created a lot of challenges at the beginning of the way. Um, that's still a big challenge. We through our uh five years, it's uh money that we brought from home, literally. Uh, and or when we became profitable, all profits went back into investment into develop into developing the uh the working model. Uh, so that was a challenge. Uh but again, we're happy uh with where we are today, and to a certain extent, we're happy that we reached this point uh without owing money or or having investors that are not necessarily uh involved in the business, you know, just just want to see reports and and why is the profitability not exactly as as you told us at the beginning of the year. We did it alone. Uh, it was very, very hard. It was devastating in some parts, but uh it is still a challenge, it is still a uh I would very much like to uh speed up some processes. I think that you wouldn't sit with with a CEO that wouldn't want that to work faster, right? Um so to a certain extent, yes, if somebody uh would have come and said, hey, let's do it together faster, uh kind of a you know, strategic partner, whatever, that probably could be nice.

Dr Andrew Greenland 46:02

And in obviously your model is a very high-touch module. What are the things that limit growth for you? Is it people or systems or positioning, or a bit of all of the above?

Word Of Mouth Growth Engine

Dr Michael Averbukh 46:15

It's all of the all of all of the above, I suppose. Uh look, with in Portugal, uh at some point we had to stop and not accept new clients because it was growing too fast. We we we kind of we had to compromise on the level of service to a certain extent because we didn't have enough people to cope with the the growth. Uh so we learned our lesson. Now we have people that we interview and we put kind of on on the waiting list, and we know that they will be uh the next one to join our team uh as we grow. So people for sure. Uh positioning. We started again in Portugal, uh, with it naturally as any startup or any new new company, specifically when you're not uh high-tech, you're not selling, you know, you're not sitting in a lab creating some great machine or AI model, and then it just spreads like a virus. And then we are in a, as you mentioned, we are in a in an industry that that is heavily dependent on on people, on knowledge, on personnel, on services. So we made made huge mistakes along the way. We made huge mistakes with with the pricing, with positioning, uh, with understanding who the client is, who is, by the way, with understanding who the client isn't. Also, also an issue, right? Um so our pathway was was full of falls and and uh uh and obstacles and failures, and but we overcame it, and we do less today. Still are doing uh errors every day, but much less.

Dr Andrew Greenland 48:27

And in the growth and expansion that you've had, how do you always strive to protect quality? Because I know you're all about quality. How do you make sure that quality is preserved?

Dr Michael Averbukh 48:38

Uh so I that that's actually that's that's another another thing that we are very happy with and proud of. I think that the method that we uh came up with and and uh and made it better, sharper, clearer for anyone who comes along and joins the team. Uh this is um the component that allows us to be persistent and consistent with delivery. This is actually what made us so sure that we can go into a market that is in different aspects larger than the market of Portugal in London. This is what made us sure that we can uh succeed as well in Spain, because the method that we developed and the approach to everyday work wouldn't change. Uh, we created it in a way that it will work practically everywhere, naturally, like it happens in any place on earth in medicine or or or healthcare, the clients would present different needs, and the clients would probably speak different languages, and the system would be different. But as previously said, we're not trying to replace anyone, we're just trying to manage a journey of the client, and the journey of the client in terms of healthcare, regardless the language they speak, or regardless where they come from, is human physiology, human psychology. It's a different language, but it's the same human being, and this is why there's a good fit between what we provide and what might be the need of a person, the Portuguese, Spaniard, German, Englishman, whoever.

Dr Andrew Greenland 50:55

What's the um biggest time drain for you personally in your work? Things that kind of you would rather not be spending time doing, or things that you don't really enjoy doing. Uh what sucks the biggest amount of time out of your week?

Dr Michael Averbukh 51:11

Actually, I I love what I'm doing, so I'm not really at work even when I'm at work. Uh what I wouldn't like to do, uh there's a thing that that I don't like, and actually uh we don't like as as as uh as owners of company. This uh sometimes kind of uh drains us, and then when you look at it in a perspective, maybe maybe we're not we're not taking it correctly. There are mistakes, and as I said before, we do mistakes, we're only humans, but there are mistakes that are repetitive. I wouldn't want if if I could, I would make this magic and uh create a system in which a mistake is done. This is only natural, but there's only one mistake uh performed, and then everybody learned from it, and everybody's now uh doing it better. A repetitive mistake is something that uh that drains energy. Sometimes uh you know you get a little bit crazy, like how did that happen again? Uh happily it doesn't happen every day all day. Uh but if I could uh ask for something not to happen anymore or repetitive mistakes.

Dr Andrew Greenland 52:47

Um if I was to give you a magic wand and you could fix one thing in the business right now, what would that be? Would it be the mistake thing or would there be something else?

Dr Michael Averbukh 52:58

Um no, I would uh I would perform a magic and make all of the team uh understand each and every time the true priorities and allow them or provide them with tools that actually I don't know if if I if you ask me what the tools are, I don't know. I would just make this magical thing that everyone manages their time better because we have we have great people, we have great people that are committed uh to their clients and are committed to perform at their best every time. Uh sometimes in a busy day it drains them a lot because nobody would go home leaving tasks behind or unattended requests from clients. Uh and sometimes they're here until uh late night because it was a busy day. Uh sometimes in it's inevitable, right? You really had a busy day, and everything fell on you on this on this specific day, but uh many times it's not your personal ability to or inability to manage your time in the most efficient way. Uh because you made mistakes along the day, again. We all make mistakes all the day, but you made a mistake and you prioritize something that you could have done differently, you could uh delegate, you could do differently, and you could make this, you can come to the same outcome uh at 5 p.m. and not at 7:30, and not feel that wow, I'm exhausted. If I could do this magic, and everything would streamline, you know, and and people would would come and go at normal hours, and everything would have been done well, give me this one.

Dr Andrew Greenland 55:18

Thank you. And finally, um, where are you looking to take Serenity going forward? What does the next sort of 12 months look like for Serenity?

Dr Michael Averbukh 55:30

I we want very much to succeed very, very well in the UK. I think that uh for us, it will be a proof that we truly learned through the five years. I mean, all the mistakes that we've done in in Portugal would not uh recur in in the UK. That would be great. I mean, we will come across many new mistakes and many new problems and whatever, and we will solve them. But I uh want to prove to ourselves that we learned uh from our five years' journey. Uh, this is 12 months, and then we will see what's next, because as I said before, uh the method works, the model works, uh, and we will probably be looking for another market in in again, not sure in 12 months, but maybe in 24 months from today, we will be looking at it in another market, most probably in Europe. Uh but this is what I want to expect.

Dr Andrew Greenland 56:37

And with that, Michael, I'd really like to thank you for your time on this podcast. It's been such a valuable conversation. Thank you for sharing your journey, how you've established Serenity, the model that you have, the know your patient um philosophy, and what you're looking to do with the business going forward. It's been really insightful, and I'm most grateful for your time this evening.

Dr Michael Averbukh 56:56

Thank you so very much for this opportunity. It's been great talking to you today.

Dr Andrew Greenland 57:00

Thank you.