Six months into his presidency of the Board of Directors of the Hospital do Divino Espírito Santo, Carlos Pinto Lopes argues that the greatest challenge facing Ponta Delgada’s principal hospital is not simply the construction of new buildings. It is rebuilding the institution itself—its governance, internal communication, financial planning and human resources—before a €280–300 million reconstruction begins. “If the hospital is not organized when the works start,” he warns, “it will collapse.”
Hospitals can survive old walls more easily than they can survive broken systems. That, in essence, is the diagnosis Carlos Pinto Lopes offers of the Hospital do Divino Espírito Santo in Ponta Delgada. Having joined the Board of Directors in November 2024 and assumed its presidency in March 2026, he inherited an institution still marked by the consequences of the fire, the addition of a modular hospital, years of fragmented management and an internal regulatory framework dating from 2009. A Deloitte audit, resumed and updated under the current administration, confirmed what Pinto Lopes says had already become evident: the HDES required not a collection of isolated corrections but a “deep and structural” reform of its governance model. The fire exposed weaknesses that had accumulated over time, but it also made postponement impossible.
The response has begun with something less visible than new operating rooms but potentially just as consequential: reorganizing how the hospital works. Purchasing has been separated from procurement and stock management; financial management is being restructured; a new internal regulation has been drafted; and services are being pushed toward annual planning of equipment, consumables and other needs rather than relying on ad hoc decisions. Pinto Lopes describes the hospital as having functioned too often like an archipelago within an archipelago—clinical and non-clinical “islands” that communicate insufficiently with one another. Poor communication, he argues, produces duplication, badly identified purchases, weak planning and ultimately greater expenditure. His objective is to have each service preparing its needs systematically for 2027 and beyond, creating a culture in which financial control emerges from better organization rather than from indiscriminate cuts.
The hospital’s debt, he insists, cannot be understood independently of what the institution is being asked to do. Clinical activity has increased, medical technology and treatments have become more expensive, and approximately 80 percent of the hospital’s program-contract funding is consumed by human resources, leaving a comparatively small share for everything else. The HDES also carries costs that derive directly from the geography of the Azores. It is the reference hospital for Santa Maria and receives patients from throughout the archipelago, including for specialties unavailable elsewhere. Once patients are referred to Ponta Delgada, the costs of repeated travel and accompanying persons may fall upon the hospital. Medically assisted reproduction is another regional service concentrated at the HDES. In an island health system, solidarity has a price, and Pinto Lopes argues that public discussion of hospital expenditure often focuses on the final figure without sufficiently explaining the obligations that produce it.
But the most formidable test is still ahead. The planned reconstruction and expansion of the hospital, expected to involve approximately €280–300 million, will have to take place while healthcare continues. Pinto Lopes describes construction inside an operating hospital as a “torment”: services will need to be suspended temporarily, transferred, relocated and reorganized as different phases proceed. For that reason, he considers it urgent to complete the execution project, move toward the international procurement process and, above all, establish the phasing of construction. “If the hospital is not organized…when it enters construction, it collapses,” he warns. The governance reform now underway is therefore not merely administrative modernization; in his view, it is the structure that must prevent the hospital from becoming operationally overwhelmed once construction begins. He is equally concerned by instability in hospital leadership, arguing that strategies requiring years to bear fruit can be jeopardized when boards change repeatedly.
New buildings, however, will solve little without people. Pinto Lopes says the HDES already suffers shortages of doctors, nurses, diagnostic and therapeutic technicians and healthcare assistants, with nursing particularly strained. More activity cannot simply be demanded from professionals who are already overloaded. Hiring additional nurses, he argues, may raise payroll costs while reducing expenditure on overtime and supplementary work. The Azores possess one advantage in nursing: regional schools train many people who are already rooted in the islands and may therefore be more inclined to remain. Medicine presents a more difficult national competition for talent. Pinto Lopes believes the future hospital, modern clinical equipment, stronger research opportunities and the development of an academic-clinical center could make the region more attractive to physicians.
That is where the University of the Azores enters the hospital’s future. Pinto Lopes does not believe the HDES should dominate a future academic-clinical center; he argues that the University should lead it in partnership with hospitals and other healthcare units. The HDES already has significant scientific activity, including genetics research led by Luísa Mota-Vieira, and the new hospital’s functional program includes areas devoted to research, education and training. More physicians earning doctorates could strengthen both the hospital and the University’s medical teaching capacity. The possibility of expanding medical education in the Azores beyond its present early years would, he suggests, create another reason for doctors to build careers in the region. Infrastructure, research and teaching thus become parts of the same strategy: retention cannot depend only on salary when professionals are also looking for places where they can develop intellectually and scientifically.
The same systemic thinking shapes his interpretation of waiting lists. He calls them “a war,” but cautions against treating them simply as a single large number. A patient waiting for a first specialist consultation may later require diagnostic exams and surgery; if the hospital then lacks operating rooms, inpatient beds or nurses, the entire process accumulates at a bottleneck. Waiting lists, he argues, will never disappear entirely. The task is to identify where patients stop moving through the system and relieve those points of congestion. A larger hospital can provide more beds and operating capacity, but only if staffing grows with it. Buildings without nurses merely relocate the bottleneck.
Asked to identify three priorities for the next mandate—whether or not he remains president—Pinto Lopes offers no grand slogan: begin the new hospital construction, complete the governance reform, and reorganize communication between clinical and non-clinical services. They are, he says, “three extremely urgent” priorities.
That may be the central paradox facing the HDES. The most visible transformation will eventually be concrete, glass, wards and new medical equipment. But the transformation upon which everything else depends is almost invisible: a purchase ordered correctly, two departments speaking to each other, a nurse no longer carrying an impossible workload, a patient moving through the system without becoming trapped between consultation and surgery.
A hospital can be rebuilt in phases. Trust, organization and institutional coherence are harder to reconstruct.
And before the first walls come down in Ponta Delgada, Carlos Pinto Lopes is arguing that those foundations must already be in place.
Based on an interview conducted by journalist Vasco Blayer in Diário dos Açores – Paulo Viveiros, director. The photos are also from DA.