13Th BRAZILIAN HOSPITAL CONVENTION Access the Main Health Exponents Meet in Salvador-BA

YEAR 8 | 28th EDITION

13th BRAZILIAN HOSPITAL CONVENTION Access the Main health exponents meet in Salvador-BA. online magazine

FBH presents Interview Artigo unpublished FBH’s new president speaks of the Compliance and studies on hospital challenges and priorities of his the constant management in Brazil mandate for the next three years health evolution 2 | PRESIDENT’S WORD REVISTA VISÃO HOSPITALAR

MANAGEMENT FOCUSED ON THE DEVELOPMENT AND QUALIFICATION OF THE SECTOR

A new management began in April of this year for our Brazilian Hospitals Federation (FBH), based on respect, ethics, loyalty and commitment to develop, evolve and train the hospital sector, continuing the work built by the Board of Directors and by the previous presidents.

An entrepreneurial and committed leadership for a new time assumes with me the challenges faced by our representativeness, because we, who understand closely the struggle for the survival and evolution of the hospital sector, realize that it is necessary to innovate, and not only this, it is also necessary creativity to continue investing, ADELVÂNIO FRANCISCO MORATO developing processes, treatments and people, for the Brazilian Hospitals Federation’s (FBH) President. continuous improvement in the care and attention to the patient’s health.

July 2nd, Hospital Day, is a time when we reflect on operating conditions to the 4,267 private hospitals our role and how we must always awaken to continue existing in Brazil today. our struggle for the defense and development of health facilities. A hospital does not only care for We are confident of a new time, and it is with this its structure, its employees, patients, protocols, spirit that we will present a more mature 13th treatments and processes; it is also largely responsible Brazilian Hospitals Convention (13th CBH), focused for feelings that generally permeate the relationship on the Health Sector’s unity, in alliance with the main between patients and health professionals working institutions of the country, so that the presentation in a hospital unit. A relationship that bonds family of strategic themes led by keynote speakers to references and eternalize moments. This very special develop partnerships and experiences to improve date for FBH recognizes the importance of this qualification, service and results enrich us with their valuable equipment for humanity’s history and for experiences, examples and practices! today’s societies development. My mission as the new Federation’s President is to be The FBH is a pioneer entity in the defense of private an instrument, with the entire FBH Board, guiding the hospitals in Brazil and has been involved in important path towards opportunities that help and promote struggles for better remuneration for hospital opportunities for the development of people, services and for a tax policy that offers adequate hospitals and clinics.

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Chief editor President General Secretary Supervisory Board - Viviã de Sousa - 12118/DF Adelvânio Francisco Morato Luiz Aramicy Bezerra Pinto Effective Members [email protected] Fernando Antônio Honorato Vice-President Deputy Secretary da Silva e Souza Graphic Project Eduardo de Oliveira Ivo Garcia do Nascimento Leonardo Gigliotti Barberes Viva Comunicação Group Edivardo Silveira Santos vivacomunicacaogroup.com Vice-Presidents Director Treasurer Altamiro Bittencourt Mansur José Mansur Supervisory Board - Marketing Eduardo de Oliveira Alternate Members [email protected] Manoel Gonçalves Deputy Treasurer Roberto de Oliveira Vellasco Carneiro Netto Glauco Monteiro Cavalcanti Maurício Souto Maior Executive production Reginaldo Teófanes de Manso Benno Kreisel Rosana Oliveira Araújo [email protected] Francisco José Santiago Cultural Activities’ Board Directors Advisors de Brito Director Leonardo Rocha Machado Proofreading José Pereira Marcus Camargo Quintella Ibsen Pontes Moreira Pinto AV Revisão Textual Mauro Duran Adan Élson Sousa Miranda Superintendent Content production Luiz Fernando C. Silva Felipe Nabuco [email protected]

Print run 7 thousand copies

Art and Layout Viva Comunicação Group Federação Brasileira de Hospitais - FBH vivacomunicacaogroup.com SRTVS Qd. 701 - Conj E - nº 130 - 5º andar Ed. Palácio do Rádio I - Torre III - Brasília-DF Publication 70340-901 Tel: (61) 3044 0332 Quarterly E-mail: [email protected]

PUBLISHER’S WORD

THE ART OF MEETING the development of the Health Sector. And, recognizing that training and information are capable of providing “Life is the art of meeting,” said our poet Vinicius significant changes in care evolution, it brought together de Moraes. While there are so many obstacles and key executives and areas and translated that into the difficulties on the way to the prosperity of the Health Hospital Manager’s Manual, a tool for guidance and Sector, there are also many opportunities! The meeting decision making of hospital managers. is necessary not only between doctor and patient but, especially, with the whole chain that revolves around This edition presents special reports on health this care, in order to provide paths, dialogues, business, compensation models, immunization, digital health, improvements and opportunities for the development permanent education, coverage of the main events of the of an entire structure capable of promoting care for sector, interview with FBH ‘s new president and much more. people. Thus, in the 28th edition of the Visão Hospitalar Magazine, we registered the main information, news and We continue with you in the search for contents and content to enhance the strategic art of meetings at the information that aggregate in the daily events of hospital 13th Brazilian Hospitals Convention (13th CBH) and to management, highlighting the main areas and thematics improve and expand the hospital capacity. that involve the universe of this mission in the care of the life, the people and the sector. The Brazilian Hospitals Federation (FBH) invests in data collection and presents its second edition of Hospitals Scenario in Brazil because it understands that data and GOOD READING information are strategic to guide plans and actions for Viviã de Sousa | Publisher SUMMARY

HEALTH TOURISM 6 INTERVIEW – Adelvânio Francisco Morato 8 13th BRAZILIAN HOSPITAL CONVENTION 12 8INTERVIEW th 13 CBH’S SPEAKERS 14 FBH’S NEW PRESIDENT SPEAKS OF THE CHALLENGES AND PRIORITIES STRATEGIC PARTNERSHIP 40 OF HIS MANDATE FOR THE NEXT THREE YEARS 13th CBH’S SPONSORS 42 13th CBH’S SUPPORTERS 46 PERMANENT EDUCATION 54 PREVENTION 56 ETHICS AND COMPLIANCE 58 DIGITAL HEALTH 60

1213TH BRAZILIAN HOSPITAL CONVENTION ALTERNATIVE PLATFORM 62 MAIN HEALTH EXPONENTS MEET IN SALVADOR-BA HOSPITAL DAY 63 HEALTH AND ECONOMY 64 HOSPITALAR 2019 66 IMMUNIZATION 70 HOSPITALMED 2019 72 SUPPLEMENTARY HEALTH 73

58ARTIGO PERMANENT EDUCATION 74 COMPLIANCE AND THE CONSTANT HEALTH EVOLUTION WELL-BEING 76 HEALTH AND ECONOMY 78 FBH’S SCHEDULE 80 PATIENT’S SECURITY 82 CHAGAS DISEASE 84 HOSPITAL INVESTMENT 86 AHOPAR 89 66FBH PRESENTS UNPUBLISHED STUDIES ON HOSPITAL MANAGEMENT FBH AT THE CONGRESS 91 IN BRAZIL HEALTH SECTOR EVENTS’ CALENDAR 94 ECONOMIC INDICATORS 96 HEALTH TOURISM

AHERJ HOLDS 1ST HEALTH TOURISM FORUM IN RIO DE JANEIRO

THE OBJECTIVE OF THE EVENT WAS TO DISCUSS HOW EXCELLENCE IN HOSPITAL SERVICES CAN PROMOTE TOURISM IN BRAZIL

The Association of Hospitals of the Rio de Janeiro demand for hotel rates, demand for transportation, State (AHERJ), in partnership with the Tourism food, tours, products and services consumption. School of the Federal University of Rio de Janeiro (Unirio) and the Brazilian Hospitals Federation (FBH), promoted, on April 17th, the 1st Health Tourism Forum. The meeting took place in the Tomorrow Museum and was supported by the Rio de Janeiro City Hall and Tourism State Secretary.

The Forum brought together various authorities and leaders from health areas, aesthetics, tourism and hospitality in order to discuss ideas and improvements to receive this demand from tourists seeking quality health services at more favorable prices.

QUALIFICATION One of the central points of the discussion on how to promote health tourism in Brazil necessarily involves the current qualification of hospital institutions. “The hospitals need this recognition, because it is about a traveler group seeking in Brazil quality and specialized medical treatment, better costs and deadlines that also meet their need to know and to make tourism in a new country”, explains AHERJ’s president, Mansur José Mansur.

In the Global Healthcare Resources Medical Tourism Index, Brazil ranks only 22nd among top international health tourism destinations. The country has a lot to grow and stand out, given its network size and quality of the existing establishments. However, there still need to be investments in the industry to attract these international patients. With that, the result would be a chain reaction, with the increase in

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SOLEMNITY The Forum opening ceremony was attended by AHERJ’s president, Mansur José Mansur; by the Tourism municipal secretary, Paulo Jobim; Embratur’s president, Leônidas José de Oliveira; Tourism state secretary , Otávio Leite; FBH’s president, Adelvânio Francisco Morato; and Professor Telma Bassetti, director of the Tourism School at Unirio .

COCKTAIL The event was concluded with the launch of the book “FBH - A History of Struggles and Challenges”, which tells the ten years of Luiz Aramicy Bezerra Pinto management as the head of FBH.

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ADELVÂNIO FRANCISCO MORATO - FBH’S PRESIDENT

“In a country with so many difficulties, we want to be heard, to be respected by everyone, in defense of large, medium and small Brazilian hospitals”

The new Brazilian Hospitals Federation (FBH) president, Adelvânio Francisco Morato, 58, is a physician, urologist surgeon, graduated from the Federal University of Espírito Santo (UFES) and postgraduate in Administration and Cooperativism. He was the secretary-general of the Medical Association of Goiás (AMG) and member of the Union of Hospitals of the state. Currently, he is one of the partners of the Instituto do Rim de Goiânia (IRG).

Morato is in his third term as the head of the Hospitals Association of Goiás State (AHEG), position that he accumulates with the FBH presidency for the triennium 2019-2021. In an interview for the Hospital Vision, the new FBH president talks about the challenges and priorities of his mandate for the next three years, the importance of the publications released by the entity this year (“Hospital Scenario in Brazil” and “Hospital Manager’s Manual” ) and expectations with the 13th Brazilian Hospitals Convention (13th CBH). Check below:

V.H. – You assumed FBH presidency just over two months ago. What are the main goals for the next three years?

A.F.M. - The main goal is to further strengthen the Federation. Expand its legitimate representativeness throughout the national territory. We want that, in all states, there is an association federated to FBH, because, in this way, we will be unifying the country, strengthening the fight and increasing the representativeness of Brazilian hospitals.

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V.H. – In recent years, FBH has been leading the V.H. – How do you evaluate the new market debate on the Brazilian health system. In what main opportunities, as is the Health Tourism case, a topic subjects will the entity act in its management towards that is on the rise in Brazil? the defense of private hospitals? A.F.M. - FBH has envisioned Health Tourism for A.F.M. - Firstly, we will intensify the discussion about some time, through our former President, Dr. the necessary reduction of taxation at the hospital Luiz Aramicy Pinto. In his management, the FBH level. Brazilian tax system is one of the most complex Internationalization Department was created, in the world, and the burden on hospitals is cruel, it is which took the entity back to the IHF (International extremely onerous. Therefore, this is a priority theme. Hospital Federation). This return evidences a great The second one concerns hospital management field of evolution for Brazilian hospitals, and FBH qualification. We need to focus on actions aimed will continue this work. We understand that Brazilian not only at the qualification of work processes hospital tourism already exists, what we need to do is within hospitals, but, above all, at the qualification to organize it, promote it, put in evidence through our of the hospital manager himself. There are other hospitals qualifications, and, with that, attract tourists lines of action that also demand attention, such as who come to enjoy the ride or also to treat diseases. discussions that FBH has been leading, concerning Therefore, Health Tourism is also one of the topics the return of the psychiatric hospitals to the mental that will have our due attention. Our goal is to follow health network, together with Health Ministry, as well up the excellent work that has already been carried as in discussions about the revision of the UHS table. out by FBH on several fronts, working to protect the hospital as a whole and taking it to where it deserves. V.H. – How do you evaluate the challenge for hospital In a country with so many difficulties, we want to be management to discuss new remuneration forms heard, to be respected by everyone, in defense of the with health plans? large, medium and small Brazilian hospitals.

A.F.M. - It’s a big challenge, but FBH is prepared. V.H. – FBH is one of the entities with voice in the Prepared to discuss without accepting any type of Working Group (WG) that discusses the SUS table imposition from health operators, with a friendly revision and modernization at the National Congress. discussion, a discussion between parties, where we Why is this review a priority on the sector’s agenda? can diagnose and achieve the most assertive model. I believe there is no better compensation model; there A.F.M. - Firstly, I would like to say that I did not want is, in fact, the most fair model for each discussion. to talk about table. The amounts paid by the SUS So we need to first make operators understand that nowadays are extremely out of date. There is an they need to sit at the table, unarmed, without any immense difficulty in attending SUS users. Therefore, political denotation, and look at the patient’s side, we need to urgently promote a study of these values so the hospital side and the operators’ side. This is how that we can reach a common denominator. Hospitals we will reach a common denominator. need a differential in the attendance, because every

| 9 hour that passes, we will expand the difficulties, all managers will have qualified information about especially in the countryside, in those hospitals that the sector, and we, the Federation, are accomplishing relies solely in SUS or by any other plan. We need our main objective, which is to promote network to discuss this so that we have a greater vitality, qualification for Brazilian hospitals. because private hospitals are closing and most of them attend by the SUS. Therefore, if these values V.H. – FBH is launching, this year, two important are not reviewed, we run the risk of having a medical studies that are true contributions to supplementary collapse in our country’s supplementary health. health improvement: the “Hospital Manager’s Manual” and the “Hospital Scenario in Brazil 2019 “. V.H. – The Brazilian Hospitals Conventions represent What is the importance of these works? the historical rescue of the first events held in Brazil in order to discuss health. What are your expectations A.F.M. - FBH has a very important role with its with the accomplishment of 13th CBH that happens in representatives. It has to show Brazilian reality, Salvador-BA this year? because the Brazilian reality is not what we discuss in São Paulo. The Brazilian reality is what really A.F.M. - We must remember that Brazilian Hospitals happens at the other end of the line, and we need to Convention represents the beginning of debates be sensitized, the population needs to be sensitized, about the development of the Brazilian health system. the political class, the rulers, at the municipal, state, It spent a dormant time and came back last year, from and federal levels. We need to show the harsh the 12th CBH, which was held in Goiânia-GO. The reality of how Brazilian hospital network is chaotic. Federation cannot fail to carry out this work; on the It needs oxygen. So, as I said earlier, the amounts contrary, we want to improve it every year. Reason: it paid by SUS need to be revised. We need to rethink is taking all the sector’s experts for a strategic meeting these mechanisms for the sustainability of hospital in Northeast region. In addition, it is taking all its institutions. Therefore, concerning these two books, Federates to this event; it is bringing great speakers, the first shows the scenario of closing hospitals national and international prominent companies, so it and hospital beds of private network throughout is the way that the Federation values its local Member. country, while the other expresses the Federation’s We are walking all over Brazil, we were in Midwest, concern in qualifying its hospital, its manager. So, now we are in Northeast, so we will strengthen, with we have prepared a Manual, with expressive names, this, the local Association. We will promote knowledge including executives participation, from the National for new managers, how to do better, and this is Supplemental Health Agency, because they are Federation’s mission: to improve its hospital network, people of the sector who will show how to improve and this kind of information helps to clarify if it is on the the manager’s work, how to improve their work right path, showing that the Federation is cooperating, performance, and this is the FBH main objective: to and also shows attention to the local Association. qualify and bring qualified information of the sector Therefore, let’s make the local Association privileged; to its associates.

Felipe Nabuco [email protected]

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MAIN HEALTH EXPONENTS ARE IN SALVADOR-BA

IN ADDITION TO BRINGING TOGETHER BRAZILIAN MAIN LEADERS, THE LARGEST HOSPITAL EVENT IN THE COUNTRY IS ALSO ATTENDED BY INTERNATIONAL SPEAKERS FROM COLOMBIA AND FINLAND.

In first week of August, Salvador, once the first For the Convention solemn opening, two international capital of the country, will once again be the center speakers are awaited with great expectation: of attention for the Brazilian health market. The 13th Colombia’s former Health Minister and current Brazilian Hospitals Convention (13th CBH) promises to general director of Colombia Association of Hospitals be a landmark for the historic city, promoting strategic and Clinics, Juan Carlos Giraldo Valencia; and meetings, speeches on topics that are on the priority Kuopio’s executive director of University Hospital agenda of the sector and expertise exchanges among District from Finland and the next International managers from different locations in country. Hospital Federation (IHF) president, Risto Miettunen.

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EXPECTATIONS SPEECHES The criteria and precautions of the Scientific The Convention methodology provides for more than Committee to choose themes and speakers have 20 speeches, which will be offered simultaneously been the great differential of the 13th CBH. Overall, over the two days of event, in three rooms: Result, more than 20 tables are planned on topics that Qualification and Attendance. address the improvement of qualification, care and hospital outcome. In the Result room, we will discuss topics related to the managerial performance of health units, In the main speech, former Colombian Health such as planning, organization, indicators, taxation, Minister Juan Carlos Giraldo Valencia will address compensation, among others. In the Qualification the challenges of “Management for the development room, participants will have the opportunity to of health systems.” For 18 years at the head of the discuss, exchange experiences and gain new Colombia Association of Hospitals and Clinics, Juan knowledge about tools and strategies to improve Carlos will bring some successful cases from the service. Subjects such as patient safety, leadership Colombian health system. role in people management and the importance of communication towards hospital excellence will The IHF future president, the Finnish Risto Miettunen, be discussed. The Attendance room is intended to will deal with “Trends that impact health on the observe the patient’s experience, the humanization international scene”. Risto Miettunen is a radiologist, of care. with a PhD in Medical Physics, responsible for 12 articles published in international medical journals. “The opportunity to discuss ideas for the improvement of the Health Sector in one of the “We specially designed this program taking into largest events in the area is certainly an honor and an account the most current issues and the debates equally great responsibility. At this moment of strong that are priority in the strategic agenda of the health fiscal restraint in Brazil, it is not possible to envisage sector. We will bring to Salvador renowned speakers the financing expansion of public health, and it and institutional leaderships, notably recognized for is indispensable to seek efficiency gains through their work in health care throughout the country”, management arrangements and partnerships with emphasizes Brazilian Hospitals Federation’s private institutions. I believe that the 13th Brazilian president, Adelvânio Francisco Morato. Hospitals Convention is a privileged forum for the gestation of important innovations”, emphasizes Expectations and enthusiasm for this meeting were the Planning and Budget analyst of the Federal also expressed by Bahia’s capital mayor, Antônio Government, Luiz Fernando Arantes Paulo, who will Carlos Magalhães Neto (ACM Neto). According to address a speech about Management by Results in him, the city is ready to receive visitors from all the Health Sector. over Brazil, who, besides participating in a major event to promote the Health Sector, will have the More information about programming and where opportunity to know the tourist marvels of the first interested parties can sign up can be checked in the capital of the country. portal www.convencaofbh.com.br.

“We are very excited about this great event. Salvador is preparing to put on a great show during these two days and, of course, we also took the opportunity to invite participants to spend a weekend enjoying some of our music, culture, history, cuisine, beaches and everything that Salvador has and that makes this city unique in Brazil. As the mayor, I open my arms, welcome and I say that we are all waiting for the 13th Felipe Nabuco CBH participants”, said ACM Neto. [email protected]

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DATA ANALYSIS FOR BETTER CARE MANAGEMENT AND COST REDUCTION

The hospitalization costs represent more than 40% Through the alignment of incentives, OPG’s of medical expenses and have presented progressive main objective, we collaborate with the deep increases, according to the Supplementary Health transformation of the Brazilian health system. The National Agency (ANS) data from 2016. For hospitals, patient-centered care management is the basis of the analytical tools are important in the strategy of path to the revolution of welfare practices. reducing costs and increasing care quality. 13th CBH The Optum Hospitalizer OPG is a data analysis It is very gratifying to be in the largest Hospital methodology that groups clinically similar Convention in the country and to share some of my hospitalizations. With this, it analyzes and compares knowledge related to innovative analytical models, data such as resource consumption profile, hospital which are increasingly needed by hospital institutions. stay length, ICU use and occurrence of readmissions, We at Optum have a strong expertise in this segment among other strategic indicators. This allows to and we always seek to use it to contribute to the improve the performance of health facilities and seek evolution of the Brazilian healthcare sector. lower costs and greater efficiency for the system.

Brazilian hospitals are already beginning to show great interest in grouping tools, seeking to improve care management and suggest new remuneration models together with operators, based on value. These groupers provide greater efficiency and transparency in remuneration system, contribute to the alignment of financial incentives between health care providers and suppliers, and generate performance indicators. In addition, they encourage the identification of ALINE MEDEIROS abusive practices and encourage waste reduction. Optum’s medical leader in Brazil. Medical Historically, gathering data in large numbers required manager of the analytical platform for a costly, time-consuming technological effort. Today, hospitalizations focused on performance. She with the development of technology, it is possible was the medical director of Amil for more to extract relevant clinical information from medical than 11 years, and has worked in hospitals, clinics and laboratories throughout her career. bill data without the need for additional human She holds a PhD in Biomedical Engineering resources; this information makes it possible to from the Alberto Luiz Coimbra Institute for provide better and more financially efficient care. Graduate Studies and Engineering Research Our methodology was created specifically for the at Rio de Janeiro’s Federal University (Coppe/ Brazilian health system and processes data from UFRJ), graduated from UFRJ Medicine Faculty medical accounts to group hospitalizations and then and holds a Joint Commission International generate relevant conclusions. Accreditation Course.

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HOSPITAL CASE PRESENTATION - HOSPITAL PRIMAVERA

Hospital management is complex and the leadership development is an essential pillar for the evolution of care processes. The hospital manager faces daily challenges such as attending patients, observing safety and quality processes, and dealing with various clients, patients, doctors, family members, multipro- ANA PONTES fessional teams and health plans. Bachelor degree in Hospital Administration from São Camilo College, where she also holds The present work was carried out with the objecti- a postgraduate degree in Health Services ve of demonstrating the impact of a leader develop- Management. She holds a MBA in Executive ment program in a private hospital seeking for a hos- Health Management from the Fundação pital accreditation seal. This is an experience report Getúlio Vargas (FGV). based on the quantitative and qualitative approach, of exploratory nature, with explanatory and evalua- tive purposes, presented through field research and application of a structured questionnaire with objective and subjective questions.

It was possible to perceive that the program, besides directing the managers in certification process, promoted an important motivational process among the participants. A limiting factor is the lack of involvement of the operational team, which may at times overwhelm managers at tactical and strategic levels, and it is relevant that this training program model be formatted for application at operational levels as well. The “Somos Todos Líderes” program (We are all Leaders) proved to be efficient and effective, providing institutional maturity.

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HOSPITAL MANAGER’S MANUAL THE PATHS TO IMPROVE MANAGEMENT

In May 2019 we took the first step in this great With dedication to learning management from three project: we launched the Hospital Manager’s Manual perspectives, the hospital manager will be able, with at the 26th edition of Latin America’s largest Health greater effectiveness, to solve most demands that Sector fair, Hospitalar, with focus on strengthening arise in his journey. This tripod focuses on excellence and qualifying more than 4,000 health units that in hospital management in the following areas: composes the Brazilian Hospitals Federation (FBH) projects, people and processes. and beyond, since the publication is available for free in the e-book version at www.fbh.com.br. The first is to know how to manage projects. All the activities related to a health unit should be, Now the next challenge is to start a caravans’ at first, part of a detailed planning necessary for calendar focused on health excellence, working on proper execution. In this sense, seeing the hospital the themes of the Manual in a cyclical educational management as a constant project management will process, sharing knowledge with the network. The give the leader a better organization of activities caravan’s programming will be presented during the inherent to the work’s conduct, detailing the 13th Brazilian Hospitals Convention (13th CBH), in responsible ones, the necessary deliveries, as well as Salvador-BA, on August 1st and 2nd, 2019, in a lecture the primordial resources. on the topics of this project. Next, we recommend that the hospital manager We have brought, through the chapters presented, be able to manage people, the second scope. For a provocation about the need for the systemic the success of projects and processes, there is vision desired in the professional that operates in no other way than the adequate selection of the the hospital management area. The approach and work team, its respective development and, also, content of the themes were intended to instill the the establishment of strategies for the survey of professional to increase their knowledge about competencies considered essential, aligned to their the subjects, without being restricted to what was roles, culminating in monitoring and evaluation of presented. The Manual did not propose to exhaust all the expected results delivery. the subjects related to the management of a hospital, but to bring light to those that we consider essential. Finally, the third point is focused on process management, advocated as an adequate systematic We are in the age of knowledge, of quick and to achieve operational excellence, since the unit is constant transformation, in which self-development focused on: a) knowing its processes - mapping them, plays a fundamental role in achieving good results. in order to know what is there and how it works; b) Those who challenge themselves permanently in managing - contract them so that their necessary pursuit of new and best practices will be more likely interconnections and agreements can be understood; to maintain their employability and positive results c) improving - to analyze them constantly, through to the hospitals they manage. possible contract breaches and opportunities of

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evidenced advances, enabling the continuous specifically contributed at the opening lecture with improvement of these processes. Andréa Prestes, at which time we will present the Hospital Manager’s Manual, a work in which we This publication, then, appeared to present the main act as scientific coordinators, with the purpose of systemic knowledge areas in hospital management, qualifying and updating students, professionals and which are linked transversally to excellence in the health managers. tripod presented (projects, people and processes), J. Antônio Cirino with emphasis on the themes that guided the chapters: Planning by Scenarios; Leadership and People; Communication; Sustainability; Remuneration; Accreditation; Qualification; Information Technology; Architecture; and Patient Experience.

13th CBH Being one of the Hospital Manager’s Manual organizers and writer of the chapter on Leadership and People ANDRÉA PRESTES left me very grateful and happy. The fact that I can MBA in Hospital Management and share knowledge with health professionals is in line specialization in Quality in Health Services with my personal goals. We will present the Manual’s - Accreditation. She acts as administrative director of a large public emergency hospital themes in a lecture format during 13th Brazilian in Goiânia-GO. Hospitals Convention (13th CBH), an important event that has been promoting a lot of debate and promoting development for the Health Sector. Andréa Prestes

13th CBH J. ANTÔNIO CIRINO The 13th Brazilian Hospitals Convention (13th CBH) is PhD in Communication and an incredible opportunity to share knowledge about Sociability from the Federal University of Minas Gerais (UFMG). He is the author of the Health Sector, aiming at the mutual growth of the book “Gestão da Comunicação Hospitalar” the players involved. I welcome the opportunity to (Management of Hospital Communication) and participate in the programming of this high impact organizer of the works “Mídias e Desigualdade” event for the second consecutive year with great (Media and Inequality) and Comunicação e gratitude, considering the results that are gathered Mídia: interfaces com a cidadania e com a in the congressmen and exhibitors interaction, cultura (Communication and Media: interfaces and the direct results to society. This year I with citizenship and culture).

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PATIENT SAFETY AND QUALITY IN HEALTH CARE

The patient safety topic is extremely important in 13th CBH our work routine. It is a subject that should be widely I would first like to thank FBH for the invitation to publicized and encouraged. participate in this important event of the Brazilian Health Sector. NAO, the organization responsible On a daily basis, health organizations carry out for the development and management of Brazilian initiatives to minimize risks and harm to the patient, standards of quality and safety in health, seeks to which reflect on the care improvement provided in support and bring to the fore all movements focused their services. on the safety and quality of health organizations. As a professional who has been working in this area for Maintaining service improvement, building a safety more than 10 years, I am flattered to participate in culture and seeking innovation are the daily struggles this important event, contributing with knowledge of health institutions. Bringing these and other issues and experience, seeking to aggregate in the debates to the fore, improving the management, quality, and between managers and leaders. care safety in the Health Sector, through the Brazilian Accreditation System, is the National Accreditation Organization’s (NAO) mission.

In our lecture, we will discuss the patient safety concept, as well as the movements and practices CÁSSIA MANFREDINI Holds a degree in Business that exist around the world, which seek to reduce the Administration and is a technologist incidence of adverse events in the care provided. We in Quality Management by the University of will also address tools to facilitate the management Santo Amaro (Unisa). She currently works as and control of these practices, including monitoring a Manager of Standards and Systems at the and verifying effectiveness. National Accreditation Organization (NAO).

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ELECTRONIC MEDICAL RECORD AS A TOOL IN STRATEGIC MANAGEMENT

The Electronic Patient Record (EPR) entered hospitals 13th CBH to improve the routine of the health professionals. To contribute with the knowledge exchange about Bringing together clinical information and assistance the importance of the Electronic Patient Record for all patient care in a single location and simplifying (EPR) for physicians, nurses and managers in the data storage, the tool ensures the standardization of area reinforces our commitment to provide the procedures, diagnostic accuracy and care quality. technological evolution for health institutions. Participating in 13th Brazilian Hospitals Convention Considering the potential of the solution, the (13th CBH), one of the area’s main events that brings Electronic Medical Record has also come to be together the strategic leaders of the sector, is an understood as the unification of all the processes excellent opportunity to discuss important topics that involve the patient inside a hospital. Access to such as care humanization, health care management up-to-date, structured and real-time information is efficiency and digital transformation of health. very valuable for the efficient management of the health institution.

While offering real-time availability, EPR also works to reduce material waste, remedies and glosses in procedures, as well as control bed occupancy. The construction of this more strategic vision, through DAENNYE BEZERRA the information generated by the Electronic Medical Nurse, specialized in Systems Audit and Health Record, allows the manager to have an efficient Informatics, with almost ten years of experience management, making more assertive decisions that in the area. Currently she is the product directly impact the care offered to the patient. manager of the MV care area.

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LEADERSHIP AND PEOPLE MANAGEMENT HOW TO PROMOTE ENGAGEMENT

Leadership and people management are topics 13th CBH discussed worldwide. What do you do to widespread It is with humility, but at the same time with pride, leadership among everyone in a hospital, a university, that I regard my participation as a speaker in the or any other company that needs to survive by largest Hospitals Convention in country - 13th delivering quality service over the years? How do Brazilian Hospitals Convention(13th CBH). I have you manage ten people, a thousand or millions already spoken at United Nations headquarters and of employees who have different professional in many congresses around the world. I participated preparation, values and positions to perform their in a seminar promoted by the United Nations role in the company? What skills, knowledge and Educational, Scientific and Cultural Organization values are needed? Can training courses solve these (Unesco), in North Korea and many other countries.I management problems? worked in the Health Professionals Support Program (PAPS), and the WK Kellogg Foundation, from 1979 to Is employee engagement a natural process or 1990. Therefore, this area was part of a good period need external, financial or recognition stimuli so of my life – it began with a project of the Catholic that adherence to the company’s mission can take Church in the north of Paraná, in the rural area of place in a way that improves the services provided? that region, where we selected leaders and prepared Does employee engagement success depend on them to improve the life quality of rural workers. an excellent team to select those who will work for the company – Human Resources (HR) team, Human Therefore, I am very proud to say that today I continue Capital or any other name given to who selects those working in health area, but now through Dentistry, who will work in the company? Do tenders or any Nursing, Biomedicine, Psychology and Nutrition other form of staff selection solve the problem? courses. Through them and all the other courses of IESB University Center, I continue to fight for the To cite just a few examples: why do countries same cause: education! like South Korea and Germany, or states here in Brazil, stand out more than others? Are Brazilian schools and universities collaborating with the professionals´ preparation who introduces work changes in the areas in which they work? Are they EDA COUTINHO - schools and universities - forming global citizens Founder and dean of the IESB University who are aware of the importance of values and Center. She holds a postdoctoral degree in ethics in fulfilling the mission of each hospital, Education from Max-Planck Institute (Berlin, every university, every company? Germany). She is the former coordinator of the Unesco Chair in Distance Education at UnB. Can families make a difference? In conclusion, these She acted as a teacher at UnB and at State are the questions we need to discuss. University of Campinas (Unicamp).

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TELEMEDICINE AND THE FUTURE OF HEALTH MANAGEMENT

The Health Sector, within the economy and in a world It is important to emphasize that emergency rooms scenario, is in a sustainability crisis, not only in Brazil, are units of spontaneous demand with the purpose but throughout the world. Inflation in this sector in of protecting the lives of those who arrive there. Brazil reached 328% between 2000 and 2018, and Therefore, these are units with many resources when compared to the National Consumer Price available; with professionals whose mental map is Index (IPCA), which was 208%, it is striking. the high complexity. Therefore, patients arriving there with low complexity clinical situations, such There are several justifications that can be given for as upper airway infection, which is the main cause this exponential cost increase in the Health Sector: of emergency care in Brazil, are often submitted to population age increase, more access and, therefore, unnecessary diagnostic and therapeutic procedures. more diagnosis, which demands more therapeutics, incorporation of new technologies and new medicines; And why is the patient going to the emergency units that is, a number of justifications that are inherent to and not checking the ambulatory? There are several the evolution of medical science and humanity itself. answers, but the delay in making appointments But waste also increases exponentially; according is one of main reasons. Telemedicine, in its direct to published data, expenditures that do not directly form to the patient, such as medical telegraphy, can impact the patient, both in the public and in the greatly assist the system in these non-complex acute private system, lie around 30% to 50%, and it is in illness situations by placing the right patient in the this issue that telemedicine can act. right place, preventing him from using unnecessary system resources, improving the patient experience, It is very important to understand that telemedicine does since it grants immediate access to the system and not only mean distance healthcare by using electronic also improves populational health as a whole by communication tools. It means, in fact, using these tools preventing low complexity cases from dividing the to reach the patient wherever he is. By digitizing care, same queue with the seriously ill in emergency units. allowing the use of support tools of digital medical decision, care assertiveness is increased, as well as bringing specialized medical expertise to areas where geographical barriers exist. Also, by working with structured fields in a digital service environment, data analysis can take place in real time. Big data and data analytics operations are easier to execute, and thus system feedback with insights derived from these data materializes in real-time. EDUARDO CORDIOLI A palpable example is the waste we have with Master degree in Science and an Executive consultations on emergency units in supplemental MBA from the Teaching and Research Institute health. Data from National Supplemental Health / Hospital Israelita Albert Einstein (Insper / Agency (ANS) show that we have, annually, more HIAE). Since 2001, he works at Albert Einstein consultations on emergency units than numbers of Hospital, where, from 2016, he began to act as beneficiaries in the supplementary health system. a medical manager of the Telemedicine Center.

| 21 13th CBH’S SPEAKERS

DRG COSTING AND PRICING

Following a worldwide trend, health costs in Brazil are Given this background, the presentation will explore increasing. The health plans readjustments are usually how to calculate costs and price of DRGs, considering much higher than current inflation, and the economic- each group severity levels, using reliable data, a cost political crisis that has impacted a sharp reduction system that meets the needs of this methodology, in the number of health plan beneficiaries, falling with criteria and methods, providing reliability, from 51 million to approximately 47 million, many transparency and dynamism for future negotiations containment measures have been adopted by all conducted through the DRG. players in the health market in order to contain costs, provide sustainability and make the system viable. 13th CBH With great satisfaction, I was invited to attend as a The Health Sector has adopted methodologies and speaker of the largest Hospitals Convention in the tools as options for cost reduction and performance country (13th Brazilian Hospitals Convention - 13th improvements; among them, a highlight is the CBH, conducted by Brazilian Hospitals Federation - maturation and growth in the adoption of DRG FBH). It is very gratifying to be able to share ideas, (Diagnosis Related Groups) methodology as an exchange information and knowledge with industry alternative, and which has also been used as an option icons, providing a lot of learning, and still be able (as in other countries) for a new remuneration model. to contribute to the enrichment and improvement of the management of an industry that has been The DRG classifies patients into homogeneous groups constantly challenged in the pursuit of cost reduction that consider the comorbidities, physiological system, and viability of the sector through the return of age, surgeries and other procedures performed that growth. There will be many discussions on the new can alter each patient’s treatment, providing the use of remuneration models, the constant search for quality more or less inputs depending on the group in which improvement, the difficulties of financing and, at the patient was classified, thus allowing a comparability the same time, the need for constant technological and predictability regarding the outcomes and resource updating, in order to always offer the best treatment consumption (materials, drugs, length of stay), grouping to the population. It is always very enriching and the patients of certain pathology by levels of severity necessary to discuss all these topics, participate (low, moderate, high, extreme) . and get involved in the whole context of the Health segment. Thank you, FBH, for the opportunity! The need for reliable information to provide accurate costing by DRG severity levels is critical, both for performance evaluation and comparability of supplies used, predictability and pricing for trading through this remuneration format. EDUARDO REGONHA A dynamic and structured cost system that enables Doutor em Ciências pela Escola the generation of information that meets the needs Paulista de Medicina da Universidade Federal de of the DRG model is essential. Thus, it is important São Paulo (EPM/UNIFESP) e, atualmente, coordena to highlight that, for a good negotiation in this new o curso de MBA em Administração Hospitalar da model, knowing the costs and defining a good basis Faculdade Unimed, no qual é professor de Custos for pricing the DRGs are indispensable conditions for e Controladoria, Finanças e Custos, do curso de success through this new remuneration format. Gestão de Clínicas Médicas PEC da FGV-SP.

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THE LEGAL IMPACTS OF GDPR PROTECTION AND HANDLING OF HEALTH DATA

Data protection has become a guideline for private LUCAS ALVES DA SILVA BONAFÉ institutions, governments and citizens like never Lawyer, holds a postdoctoral degree in Social before, especially after cases of personal data Control of Public Policies by the Court of breaches worldwide. In Brazil, the new General Accounts of the Municipality of São Paulo and Data Protection Regulation (GDPR) advent brings a holds a degree in Data Protection and Privacy from the Institute of Education and Research range of new rights to be exercised by holders and (Insper). He is a member of the Legal Committee duties to be fulfilled by those who have access and of the Brazilian Institute of Social Health exercise their activities through personal data, in Organizations (IBROSS), Research Group for Data addition to creating a National Authority specially Protection and Privacy of the National Private focused on the supervision and application of Hospitals Association (ANAHP) and the Working sanctions in this area. Group on Data Protection and Privacy of Brazilian Association of Diagnostic Medicine (ABRAMED). Health care, one of the most impacted by the new data protection era, could become a pioneering sector in data protection and privacy. For this reason, the 13th Brazilian Hospitals Convention (13th CBH) will present the panel “The Legal Impacts of GDPR - Protection and Handling of Health Data” on August LUCAS MACEDO DE MAGALHÃES 1st, 2019, Thursday at 2:30 p.m. in Salvador- BA, Holds a post-graduate degree in Business Law which will address the main aspects of the Law, the from the Education and Research Institute challenges it will bring to the health market and how (Insper). He is a member of the Research Group organizations can prepare for the challenges and for Data Protection and Privacy of the National opportunities that the GDPR represents. Private Hospitals Association (ANAHP) and of the Working Group on Data Protection and Privacy of Brazilian Association of Diagnostic Medicine (ABRAMED).

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THE IMPACTS OF GDPR ON THE PATIENT’S EXPERIENCE

From August 2020, companies of all sizes and segments will need to ensure that their stakeholders formally authorize the collection of their personal information. Companies must also assure customers the right to know the mapping purpose, who will have access to the data, how it will be stored, and whether RICARDO MEDINA information will be shared. The requirement comes MBA in Marketing at the Graduate Institute and into force due to the new General Data Protection Research in Administration (COPPEAD) from Regulation, also known by the acronym GDPR. Federal University of Rio de Janeiro (UFRJ) and an MBA in Marketing / Management at IBMEC, Although there is much alarm about this issue, we as well as specializations at institutions such as Singularity University and Kellogg Management believe that organizations can benefit from the - Northwestern University. new regulation, which will bring greater security to citizens, standardizing processes and imposing penalties on those who fail to comply with the rules.

In our view, even if it is compulsorily, compliance creates an opportunity for companies to have more qualitative data, since the base will be composed only of people who have effectively demonstrated GUILHERME FERRI an interest in maintaining a relationship with the Strategist in Service Marketing. He holds a organization. With this, it will be possible to engage degree in Advertising and Marketing, a MBA and retain customers through more transparent, from Fundação Getúlio Vargas (FGV), and personalized and effective contacts, optimizing the specializations in Pennsylvania University, customer experience in contact with the brand. Copenhagen Business School, IE Business School and Rotterdam Management School. In our talk, we will discuss how the marketer should prepare for GDPR to ensure the best patient experience in the relationship with the brand.

13th CBH We are honored to be invited to speak at the largest Hospitals Convention in the country and to discuss such a sensitive issue in the healthcare field as the GDPR rules and the impact on the patient experience. Undoubtedly, it is a theme that will impact the entire ecosystem, and we must prepare adequately for the changes that are to come.

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EVOLUTION AND HUMANIZATION IN HEALTH SPACES FOR PSYCHIATRIC HOSPITALS

The hospital architecture is a healing instrument of EMERSON DA SILVA same status as a diet, a bloodletting or a medical Architect and urban planner by the Federal 1 gesture. (FOUCAULT, 1979) University of Santa Catarina (UFSC) and specialist in Biosafety by the UFSC Department of Microbiology THE ENVIRONMENT INFLUENCES AND IS and Parasitology (MIP). He is currently ABDEH’s INFLUENCED BY THE USER president for 2017-2020 management.

An appropriation of a place is more than using it, because The humanization of environments seeks to qualify we integrate it into our experiences. The participant is the constructed space, so as to promote physical and part of a large-scale scene, in which he moves and ends psychological comfort to people in order to carry out up assuming multiple perspectives in space. activities with feelings of well-being.

Research has indicated that poor design may have In order to achieve the desired humanization, it is negative consequences for patients, such as: anxiety, essential to understand the users’ experiences, as delirium, high blood pressure and increased use of they affect attitudes, behaviors, feelings, sensations, pain medication (WILSON, 1972; ULRICH, 1984). opinions, memories, actions and reactions. Analyzing how experiences are shaped, understanding how the interface Therefore, it is necessary to be aware that people are between the service and the user happens, can be a good fundamental pieces in the environment definition, way to promote environments that contribute to health making possible the projection of a new space care, especially when we talk about mental health. capable of meeting and surpassing the anticipated needs, bringing users closer to their own nature, The presentation will address some positive feelings, thoughts and values. experiences in the area, bringing to the discussion agenda the need to understand the users’ journey, the contact points they establish throughout the service, and develop solutions that can generate satisfaction for patients and employees of psychiatric hospitals.

RONALDO LARANJEIRA 1 FOUCAULT, M. Microphysics of power. Rio de Janeiro: Graal, 1979. Psychiatry PhD from London University. Currently, he is a titular professor at the Psychiatry Department of the Federal University of São Paulo (Unifesp). In 2014, RAFAEL BERNARDON he received the Griffith Edwards QUIRINO CORDEIRO JR. Master degree in Forensic Award from the International Society Former general-coordinator Clinical Psychiatry from the of Addiction Journal Editors in of Mental Health, Alcohol and Institute of Psychiatry at King’s recognition of his role as a clinician, Other Drugs at Health Ministry, College (London, UK). He holds educator, and implementer of public has been operating for more a specialization in Health Care policies on alcohol and drugs. He than 20 years at the Mental Management. He is currently the is the president of the Paulista Health area. Currently, he is the technical director of the Center Association for the Development of secretary of Care and Prevention for Integrated Mental Health Care Medicine (SPDM). of Drugs at Health Ministry. of Vila Mariana.

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HAPPINESS SCIENCE FOR THE HEALTH SECTOR

Initially, and briefly, Positive Psychology will be 13th CBH presented, its history and motivators, study forms An event about health that wishes to deal with and conceptual model, because it is the basic science happiness shows the concern for the integrity of the that studies happiness. Then, the happiness concept human being, and not only with treatment of diseases. will be approached as a positive emotion, and how It is a pleasure to contribute to the health awareness emotions in general impact our lives in a positive expansion beyond medicines and to lead professionals way, breaking the paradigm that emotions are bad and leaders to see an improvement in their life quality, for business and should be minimized. performance and results with patients. Many positive emotions fill me at this moment as a psychologist, We will present the positive impact of the happiness dedicated to bringing more happiness to people, and study specifically on health and the recent as a human being who continues to believe that doing research that supports this thesis. Studies by Sonja the best for the world begins in finding the best within Lyubomirsky and others have revealed that our level each one of us. of happiness is determined in part by our genetic makeup (50%), partly by circumstance (10%) and partly by environment (40%), which defines our own happiness’ level through our thoughts, choices, actions and behaviors. It will be, then, a moment of reflection on what thoughts, actions and behaviors can boost our lives towards more happiness. ISIS MENDONÇA Psychologist, specialist in Positive The benefits of happiness for certain ill patients and Psychology integrated to Coaching and holds for area workers will also be presented as well as a Master Degree in Capital Impacts of Positive Psychological in each type of Personality, practical ways of putting this into everyday life and by the Enneagram at Federal University of into professional practices. Sergipe (UFS). She is the idealizer of the Positive Assessment, a tool to identify the human potential for the development of people and leaders from Positive Psychology and the Personalities Enneagram.

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HOSPITAL 360°

“Hospital 360°” is a proposal that outlines the way with the internal institution needs, but also society forward for state-of-the-art hospitals in response needs, with a view to long-term benefits in building to changing contexts that are being generated a better world. around the world, including the demographic and epidemiological context, the technological and information context, the institutional context and the environmental context. It seeks the step towards a better level of integrated care that develops a continuous and effective health care, maximizing JUAN CARLOS GIRALDI the value and experience delivered to the patient, Colombian physician-surgeon, specialist through the inclusion of new care modalities, in Senior State Management by the Public articulation with the other agents of the system and Administration School (Esap), with studies in coordination of the different processes that occur Formulation and Evaluation of Programs and simultaneously in the institution operation, through Social Projects at the Economic Commission for Latin America and the Caribbean (ECLAC). He disruptive technologies and the use of ICT, favorable holds a Master degree in Health Administration environments and intellectual capital, in order to from Colombia’ Javeriana University and make hospital activity more flexible in different Management of Health Centers and Services environments and particular situations. by the University of Barcelona. He was a Health Minister Deputy; Health Minister in charge. He is Therefore, the “Hospital 360°” proposal pursues currently the general director of the Colombian objectives of efficiency, effectiveness, relevance, Association of Hospitals and Clinics, a position impact and sustainability, its objectives are consistent he reached in 2001.

LEADERSHIP IN HEALTH 4.0

The Fourth Industrial Revolution inspired changes in leadership across all sectors, and that would be no different for the Health Sector. Health leaders are constantly faced with market movements and MARCUS CARVALHO uncertainties that inspire new leadership and team Physician, holds a post-graduate in skills and abilities. Business Management and in Management, Entrepreneurship and Marketing. He is the The “new leadership” must have the ability to see president of the International Meeting for opportunities in uncertainty, make the transition to Physicians of HospitalarMed, the largest Brazilian these new paths, deconstructing in order to build and medical entrepreneurship event, and member of engage the whole team towards new directions. the Global Mentoring Group Academy.

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INSTRUMENTS FOR IMPROVING HOSPITAL CARE QUALITY

Over the years, patient’s quality and safety management has had its place and contribution to the improvement of processes and results of health organizations. Quality improvement requires changes in processes as well as in health professionals’ performance and behavior. GILVANE LOLATO MBA in Health Management and Establishing a plan or program for quality Infection Control and specialization in the management implementation, patient safety and International Course in Health Quality and continuous improvement, through instruments that Patient Safety by the Public Health National School (ENSP) of Universidade Nova de adapt to the organization’s reality ensures a more Lisboa, Portugal. She currently coordinates effective outcome for both the processes and the and teaches in the Quality Management and organization as a whole. Health Accreditation course of the Graduate and Undergraduate Institute (IPOG). Quality tools are important quality management instruments, which provide improvement in the result of the services offered to users.

The tools for evaluating the results of quality, certification and accreditation programs, for example, can be evaluated through questionnaire, documentary analysis, case study and interviews.

13th CBH As a professional who works in the health area, I have a purpose that is to improve health organizations within the conditions, opportunities and tools that I have at hand. I believe that we can all be agents transforming the places and, above all, the people we meet. Participating as a speaker at the largest Hospital Convention in the country is a great opportunity to aggregate value to the professionals who will be there, as well as generate opportunities for learning and exchange experiences. I realize that health professionals seek to participate in these events not only to listen to the theory, they can find that easily on the internet and in the books, but to confirm the way forward and the best way to structure this path for better results.

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MANAGEMENT BY RESULTS IN THE HEALTH SECTOR

Management by results means aligning all efforts also inhibits the scientific development and makes it of the organization to promote a change in reality, impossible to offer new experimental therapies, such describable and measurable, from previously as those developed from stem cells. identified cause and effect relationships (UN, 2010). Its implementation is supported by four dimensions The implementation of results-based management, (SERRA, 2007): 1. Result as a key reference for the entire coupled with a greater centrality of the states and the management process; 2. Allocation of responsibilities strengthening of the participatory and control bodies to the intended results; 3. Integration of management of SUS, can be a tool to drive important advances in processes; and 4. Valuing an organizational culture the Health Sector, especially in the economic and with emphasis on results, not processes. fiscal scenario that Brazil is experiencing, where a strengthening in health financing is not likely, at least When analyzing the strategic management of the in the short term. Health Sector at the federal level, it is possible to verify its lack of adherence to a results-based 13th CBH management strategy. There is a low correlation The opportunity to discuss ideas for the improvement between the strategic choices and the legal of the Health Sector in one of the biggest events competencies of Union, making it impossible to in the area is certainly an honor and an equally assign clear responsibilities, while some middle- great responsibility. At this moment of strong fiscal level activities are mistakenly taken by results. restraint in Brazil, it is not possible to envisage the expansion of public health financing, and it There is a clear choice for a bureaucratic model is indispensable to seek efficiency gains through that produces inefficiencies and distortions. management arrangements and partnerships with Notwithstanding recent advances, such as the private institutions. I believe that the 13th Brazilian reduction of financing blocks and, consequently, Hospitals Convention (13th CBH) is a privileged forum greater freedom in financial transfers to states for the creation of important innovations. and municipalities, the fact is that the Federal Administration still conditions a series of transfers to comply with centrally established policies, by Ordinances of the Health Ministry.

In addition to occupying an important workforce of the Ministry of Health in bureaucratic tasks of low effectiveness, this supposedly central control weakens the local managerial capacity of the health system, which, instead of planning the best way to LUIZ FERNANDO ARANTES PAULO Planning and Budget analyst from the Federal use resources, is forced to develop a reverse strategy, Government since 2004, with passages at that is to observe policies defined at the federal level several Ministries. He holds a master degree in order to obtain funding. It is a blatant reversal in Law and Public Policy, is a specialist of the decentralization principle instituted in the in Public Management and author of the construction of the Unified Health System (SUS). book “Plano Plurianual: teoria, prática e desafios para a sua efetividade” (Pluriannual The bureaucratic management not only distorts the Plan: theory, practice and challenges to its financing of SUS to the states and municipalities, but effectiveness) (Juruá, 2016).

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VALUE-BASED HEALTH DELIVERY

We started an important debate about value-based The ways to do it are already being debated, as well health in Brazil. But the first question that is asked is: as successful international experiences that can be what is “value” for each player of the system? How used as inspiration. We need to start quickly with the do we equalize these expectations and focus on what foundations so that these models can be applied, really matters, what would be the best outcome for through quality and accessible information and the patient at the best possible cost? training of those involved in these changes.

According to Michael Porter, value-based health care We are living a transition moment in health systems. is a global healthcare system initiative whose overall It is important that we never lose the focus on care goal is to increase patient value, contain escalating quality and the centrality of care in the patient. costs, and provide better care to users. 13th CBH We face some health challenges that need to The Brazilian Hospital Convention (CBH) is an be debated in society: an increasing of patients important event to discuss challenges of the number with chronic illness - today they represent segment and present proposals for changing the 40% of population; the population’s aging, which scenario. I believe that the common goal is to show is a society achievement, but must have an impact our experiences and contribute to bring increasingly on the life quality and the restructuring of health qualified results to the sector. services; health information (whether in the form of communicating the theme or in the transmission of health data); and the care quality are still matters that need to be brought to reality.

Our compensation and assistance models still privilege inefficiency. The system requires data and strong will from all parties involved for effective change. Within this scenario, discussion of outcome indicators, debates on best outcomes, and analysis of the best ways to measure and compare populations MARTHA OLIVEIRA and their risks still seem far from ideal. Physician, specialist in Pediatrics and Public Health, and holds a Master Degree in But this can no longer persist. We have no time to Epidemiology from the same institution. She delay. We urgently need to redesign our care model, holds a PhD in Human Aging from the State organizing care in an integrated and articulated way, University of Rio de Janeiro (UERJ). She is associated with a remuneration model capable of currently the director of Strategies and New reinforcing and stimulating the outcome. Business of Qualirede.

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HOME CARE

SUSTAINABILITY FOR THE HOME CARE: PRINCIPLES, PRACTICES DE-HOSPITALIZATION PROCESS AND AND PERSPECTIVES CARE CONTINUITY This is the title of the lecture and the book recently Within the patient care cycle, it is important to published by Dr. Christina Ribeiro, which addresses emphasize the need to establish processes and the strategic participation of Home Care in Health assistance that, when complemented, meet the Systems, its contribution to the process of de- proposed goals for treatment and rehabilitation. hospitalization, transition, integration and continuity The interaction of different teams and hospital of care for patients with acute and chronic diseases. structures and Home Care ensures the care quality It describes structure, eligibility criteria, evaluation and guarantees a more comprehensive view of the of safety quality and care processes, management client’s needs, bringing a positive perception in of multiprofessional teams, main results and growth the patient’s experience. Actions that ensure the prospects of the modality in the country. sustainability of the sector.

ANDRE MINCHILLO CHRISTINA RIBEIRO physician, vice president of the Physician, pediatrician and Ideal Care Group and former director of the Home sanitarist; specialist in Health Services Administration; Care Business Nucleus (Nead). Master in Epidemiology of Health Services and PhD in Public Health Practices from the Public Health Faculty of University of São Paulo (FSP/USP). Medical Manager of Home Care Service of Hospital Israelita Albert Einstein, president of the Brazilian Symposium on Home Care (Sibrad) and president of the National HOME CARE and Regional Meeting of Home Care Services (Enconsad). Author of the book “Atenção Domiciliar: In order to enable patient’s transition, who needs princípios, práticas e perspectivas” (Home Care: continuous care, from hospital to home, as well as a principles, practices and perspectives). care plan, adequacy of human resources structure, equipment, materials and medicines, the presence of the caregiver is of fundamental importance. Cur- rently with a regulated profession, the formal caregiver, hired by the family, must present all the requirements for his professional practice, undergo training and receive supervision to validate this practice. All CLAUDIA FONSECA PEDROSA definitions and particularities about this professional Studied Biological Sciences and Management performance and its importance for safety assurance Processes. She is an entrepreneur and manager of and care quality at home will be addressed during Bom Cuidar - Assistência Domiciliar - Cuidadores. th th 13 Brazilian Hospitals Convention (13 CBH), on Au- Idealizer of the first National Congress of Home gust 1st, in Salvador, Bahia, Brazil, in a lecture given at Health Care and the National Meeting of Home the table Sustainability for Dehospitalization Process Care Services (Enconsad). and Care Continuity.

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HOME CARE

HOME CARE HOME CARE

Home Care Service (SAD) was established in the Health Sector in Brazil is already facing a huge challenge, Unified Health System (SUS) through the Best which is to provide its population with access to care Home Program in 2011, with the main objectives services, in a country with a continental geography and of humanizing health care with the expansion of full of social inequalities. With technologies such as users’ autonomy, optimization on the use of hospital, telemedicine and telemonitoring allied to home care, financial and structural resources of the Health Care we can have interesting solutions to this challenge. Network and the reduction of the length of stay of hospitalized users (de-hospitalization). Another huge challenge is to ensure the number of hospital beds for the population, considering the demographic Currently, the Program is regulated by the GM/MS transition, with the exponential increase in the elderly Consolidation Ordinances nº 1, nº 5 and nº 6, of population, and the epidemiological transition, with a September 28, 2017, which guide the actions carried significant increase in patients with chronic diseases and out by the multiprofessional teams that constitute the functional limitations. How can home care help in solving SAD: Multiprofessional Home Care Team (EMAD) and these problems in the Unified Health System (SUS) and in Multiprofessional Support Team (EMAP). As of April the complementary health system? 2019, there were 1,099 Home Care teams deployed in 413 municipalities in 25 Federative Units, with potential population coverage of 28% of Brazilians.

LEONARDO SALGADO Gerontology and Medical Clinic specialist. DÉBORA SPALDING VERDI CEO at the Assiste Vida Atenção Domiciliar, a Analyst in Social Policies at the Health Ministry, company with more than ten years of experience a psychologist with multiprofessional residency and reference in Home Care in Bahia. He is the in Basic Care and holds a Master Degree in vice-president of the National Nucleus of Home Governance and Development. Care Companies (NEAD).

SUSTAINABILITY FOR DE- HOSPITALIZATION PROCESS AND CARE CONTINUITY - HOME CARE

JOSÉ LUIZ DA COSTA LANDEIRO With population aging and an increase in the physician graduated from the prevalence of chronic diseases, it is expected that Federal University of Bahia (UFBA), specialist a higher number of medical discharges will be from in Internal Medicine and Cardiology, with patients with some functional dependency degree experience in Intensive Care Units. He holds and who demand more complex health care after a MBA in Health Management from Fundação Getúlio Vargas (FGV) and, since 2001, he has the acute hospital event, in order to contribute for been the medical superintendent of Bahia hospitals sustainability and public and private health Home Care, he is the current regional director systems. This care, called post-acute care, have in of the National Nucleus of Home Care Service Home Care their main modality, being the main Companies (NEAD) - regional Northeast. current path of de-hospitalization.

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HOME CARE

SUSTAINABILITY FOR THE PROCESS FREDERICO BERARDO OF DE-HOSPITALIZATION AND CARE Physician graduated from the Medicine School CONTINUITY - TRANSITION UNIT of São Paulo University (FMUSP / USP). He did medical residency in Preventive Medicine in The process of de-hospitalization has been debated the Preventive Medicine Department of FMUSP. in an increasingly assertive manner in the various He graduated in Epidemiology of Chronic Non- forums dedicated to the discussion on alternatives Communicable Diseases by the Pan American that are effective to ensure the sustainability of Health Organization (PAHO). Member of Chronic- the health system in Brazil. Transitional clinics Degenerative Diseases Sector of Health Institute of State Health Secretariat of São Paulo (SES- have increasingly proved to be the safest route SP) from 1983 to 1990. Founding partner and for the patient, who no longer needs the entire director of Institutional Relations of Premium highly complex hospitals structure, freeing them to Care - Transition Clinic since 2007. Professor play their part in health: acute patient care, which invited to attend the Health Administration requires research, intervention and high complexity course of the Advanced Studies Program in technological support. Hospital Administration and Health Systems of Fundação Getúlio Vargas (PROAHSA / FGV).

OPPORTUNITIES, STRENGTHS, THREATS AND RISKS OF PRIVATE HOME CARE IN BRAZIL

The Demographic and Epidemiological Transition of with solid numbers and is constantly robust in terms our country put us in situations that we glimpsed of the Quality Assurance and Assistance Security for years. The Future arrived and gave us even scale. We will discuss the Opportunities, Strengths, greater difficulties, as it was associated with welfare, Threats and Risks of Private Home Care in Brazil. economic, operational and administrative risks.

Technology is a recurring partner in our discussions which involves us with possibilities and also with incredible doubt of the most assertive ways to be followed. Home Care followed this growth and LUIS CLAUDIO MARROCHI dissipated on several fronts, becoming an important CEO of the Saúde Care. He holds a Master tool for Health Management. degree in Collective Health and a MBA in Project Management. He is the deputy chief of the Clinic The private sector is privileged in this sense with the of the Medicine Department of Santa Casa de São premature development of options for the Health Paulo and president of the National Nucleus of Plan Operators. Our sector is strong and established Home Care Services Companies (NEAD).

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UNIFIED HEALTH DATA THE DATAOPERA PLATFORM

THE PROBLEM THE BENEFITS There are several computerized health systems. They Once the patients’ clinical information is all gathered work with a certain efficiency in the management of in a single repository, it is possible to create a hospitals, clinics, offices, laboratories, health plans, precious Collaborative Health Network. With this, etc. The big problem is that the information for a service providers will have access to the patient’s particular patient is completely fragmented. This medical histories, regardless of where they were prevents a complete view of his health and generates treated, besides using BI or IA algorithms that can be additional costs, such as duplicate request for exams. efficiently applied to strategic decisions of all actors This decentralization of information also makes it for this health segment. impossible to make strategic decisions of the other actors in the health area.

THE SOLUTION The natural way to address these issues is to centralize the health data. Although it seems like a simple idea, there are several obstacles to overcome. One of these difficulties is interacting with several systems that do not “speak the same language”. Another sensitive issue is maintaining the privacy of this data. In addition, patient consent is required for the collection and availability of such data.

PAULO LÍSIAS SALOMÃO DataOpera is an initiative of the Paulista Medicine PhD in Health Informatics, a Master degree in Association (APM) in the creation of a Health Software Engineering, and a Bachelor Degree Interoperability Web Platform that gathers in Pure Mathematics. He is responsible for the information from different systems. It solves the data ClinicWeb software creation, the first electronic integration issue and stores it in a standardized way. medical record on the web in Brazil, which In addition, the General Data Protection Regulation reached the mark of 6 million patients and 5 (GDPR) advocates the anonymity and patient consent. thousand doctors.

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REMUNERATION MODELS

The National Supplemental Health Agency (ANS) the innovative implementation and alternative has a leading role in driving supplementary health remuneration models for volume payment. sector towards good practices, aiming at the constant health care quality improvement and the The next step will be the Phase 3 of TG, with the sustainability of the sector. In particular, as the experimentation of innovative compensation models country moves rapidly through the demographic in concrete experiences, with the participation and epidemiological transition, population aging, of operators and providers, willing to seek better increased life expectancy, the growth of chronic non- alternatives, and counting on the technical communicable diseases (CDNT), coupled with the cooperation of ANS for the establishment of constant incorporation of new technology in health, successive confidence gains. it is of special importance the discussion about the remuneration models of health service providers ANS believes that this is a path with no return, with and their possible repercussions on the model of the conviction that the sustainability of the Health care practiced, on health outcomes and on the Sector runs through necessary advances in the sustainability of the sector. efficient management of financial resources and in achieving better health outcomes. In this context, where health care costs are increasing, the remuneration model theme has been brought to 13th CBH the center of discussions worldwide. New models, We must thank Brazilian Hospitals Federation alternative to the classic fee for service, have been (FBH) for the invitation and the partnership that tested in different countries, both in public sector has been maintained with the National Agency for and in private sector, with different experiences and Supplementary Health (ANS) for so many years, positive results already observed. formalized in 2019 with the signing of a cooperation instrument that favors important opportunities for In Brazilian’s supplementary health care context, interaction and approximation such as this, in which ANS assumed the challenge of capturing the the ANS can disseminate its actions and projects aimed debate about remuneration models adopted in the at improving the supplementary health care quality for relationship between health plan operators and the hospitals of the country, represented, in large part, health service providers with a view to implementing by those present at this very relevant Convention. new remuneration forms based on value, which privilege the quality of services provided and which do not seek exclusively at reducing costs.

Thus, in September 2016, ANS created the Technical Group (TG) of Remuneration Models . In November 2017, the TG entered its second phase, culminating in publication of the Guide for the Implementation of RODRIGO RODRIGUES DE AGUIAR Value-Based Remuneration Models, which presents Civil servant at National Supplementary Health the consolidation of technical aspects related to the Agency (ANS) since 2007. Graduated in Law from University Center of the City of Rio de Janeiro, main remuneration models discussed and studied he holds a post-graduate degree in Public Law throughout the TG. In addition, it presents a range from Universidade Cândido Mendes (RJ) and an of propositions and guidelines that will serve as Executive MBA in Business Management from a guide for operators and providers to promote IBMEC (RJ).

| 35 13th CBH’S SPEAKERS

HEALTH SERVICES MARKETING MARKET MANAGEMENT

The health services sector, particularly hospitals and We will address the Market Management theme in clinics, has presented great difficulty in managing Health, specifically Marketing Mix, which can play the factors that generate economic, financial and so- the role of plans and strategies, which can represent: cial profitability, quality and customer satisfaction - “Profitability (economic, financial and social) - custo- the latter being responsible both for profitability and mer satisfaction and ethical morality in the provision for enterprise effectiveness as a whole. of health services”. For this, we will also discuss other marketing tools and the “ABC” and “XYZ” curves and It is necessary to consider that the great majority of their combination, as support for instrumentalization these organizations faces many other difficulties, of the so-called “marketing mix” instrument. such as the scarcity of financial and human resources; poor physical facilities; archaic technological 13th CBH processes and also errors and defects arising from In response to Brazilian Hospitals Federation (FBH) organizational or administrative structures - usually invitation, as a speaker at the 13th Brazilian Hospi- - of a high vertical format, slowing down and shuf- tals Convention (13th CBH), a condition that honors fling information flow, and, consequently, impairing us greatly, considering the importance of this entity the decision making quality. Unfortunately, in most as a promoter of the development and growth of the cases, the problems related to the management qua- Health Sector in Brazil, we will take our reflections on lity are present. the Market Management of Health Services.

This deficiency impacts the entire health care sector - blocking and hampering the development and progress already experienced by the medical and technical segment - even reaching organizations located in the most developed regions of the country, and only a few of them follow the evolution experienced in the developed world. SEVERINO FRANCISCO DA SILVA Master’s degree in Business Administration It is important to remember that “management” does and is a specialist in General and Hospital not only concern the internal functions of an organi- Administration. He was the administration director of the University Hospital of UFAL and zation, but also to the various variables of their en- is the author of the books “Marketing de serviço: vironment (macro: economic, technological, political, fundamentos, análises e prática no Setor de cultural, ecological, demographic, legal and social – Saúde” (Service Marketing: Fundamentals, Analysis micro: competitors, customers, regulatory agencies and Practice in the Health Sector) and “Gestão de and suppliers). Therefore, organizational manage- mercado na saúde – estratégia mix de marketing ment encompasses the management of internal and “ (Market Management in Health - Marketing Mix external factors (market management). Strategy) (coauthor: Prof. André Carneiro).

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DATA AND INFORMATION SECURITY

On August 16th, 2020, will enter into force Federal Therefore, it is also essential that hospitals adopt Law No. 13.709 / 2018, the so-called General Data a data protection culture, instituting policies and Protection Regulation, or GDPR. Its emergence trainings specially developed for this purpose, stems largely from the global legislative movement and reflect on several issues, such as access to led by European Union through its own General medical records, clinical protocol procedures and Data Protection Regulation, which seeks to give even the possibility of elimination or anonymity of more tools to personal data holders to control unnecessary data. information collected and processed by companies and Government. Precisely in this sense, as from the Meeting these obligations is a real opportunity for GDPR entry into force, personal data holders may hospitals to review their internal processes, engage request information regarding the personal data their employees, and reaffirm their commitments processing directly to those data controllers. to business partners and clients. It is the chance for institutions to demonstrate that care with the GDPR addresses relevant issues to health service patient is intrinsically linked to the care of their providers, especially hospitals. This is because the personal data. information routinely collected by these institutions, such as health, biometrics, genetic data, and even 13th CBH information about sexual choice, is defined as It is a great pleasure to be able to participate in 13th sensitive data. Brazilian Hospitals Convention to address a topic so relevant to the sector, which is the issue of data The law imposes that institutions that collect and processing in the hospital sector. In the event, we store personal data must disclose clearly and will conduct a practical workshop with case analysis transparently about their purposes, whether or involving hospitals. I hope you all enjoy it and not holder’s consent is necessary, and makes the together we will find the best practices. controller responsible for any damages caused, even if it occurs per action or their partners and suppliers. That is, if a hospital uses services from a clinical testing laboratory to perform tests on its patients or even employees, the hospital will be held liable to the data subject and the national authority in an incident case in the referred laboratory databases.

For this reason, it is essential that hospitals be adequately suited to GDPR by August 16th, 2020. The way to do this is to review internal processes, TERESA GUTIERREZ Specializes in Administrative Law from PUC, focusing on understanding the personal data and in Regulatory Affairs of Medicaments at journey inside and outside the institution. This Oswaldo Cruz College. She also holds a degree process involves patients’ reception, through in History from Faculty of Philosophy, Letters sectors such as Human Resources, Marketing, and Human Sciences from São Paulo University Clinical Staff, data transmission with healthcare (USP). Teresa is president of the Sanitary Law providers and even the areas responsible for Commission of the Order of Attorneys of Brazil - documents and information disposal. São Paulo Section (OAB-SP).

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INFLUENCE OF THE INFORMATION SYSTEM ON HOSPITAL MANAGEMENT

Hospitals are complex organizations that require 13th CBH advanced management methodologies to ensure Participating in the 13th Brazilian Hospitals Conven- excellence levels. Promoting, therefore, an efficient tion (13th CBH) is a great opportunity to discuss the hospital management is a fundamental step to ensu- main health issues with references of the sector. Sha- re the full functioning and even the hospital survival ring experiences and knowledge about the technolo- as a business. Hospital administration should include gy benefits in hospitals enables us to reflect on the transparent operational processes that facilitate and advances made by the segment and to understand optimize care. Management systems organize the the challenges that must be overcome if health is to institution, facilitate the financial balance, show whe- experience digital transformation. re there are unnecessary expenses, as well as other bottlenecks that can be solved more easily.

Data availability provide managers with an inter- departmental vision, facilitating the monitoring of objectives set by the institution. Having an efficient hospital management also involves building a VALMIR JÚNIOR strategic planning that depends, fundamentally, on Degree in Administration and has accumulated technology. The use of a hospital management sys- experience in hospital management software tem, which stores the huge amount of information implementation in public and private context. He generated on a daily basis, optimizes the planning has worked in more than 100 computerization and execution of the plan by facilitating access to projects in hospitals in Brazil and Latin America. As an expert on health systems in essential information. countries such as Brazil, Chile, Panama, Mexico, Dominican Republic, Peru, Colombia, Uruguay, With technology, hospital management differentia- Argentina, Costa Rica and Nicaragua, Valmir tes itself in several aspects, especially in improving presents information technology (IT) solutions data quality and extracting insights that help deci- to clients and prospects with the objective of sion making - a crucial factor for health managers. disseminating technology as a strategic tool to increase productivity, reduce costs, ensure business profitability and, mainly, improve health services. During the 30 years of activity in this area, with the MV, he carries the mission of improving the management in health institutions, and, thus, allows the population access to more qualified and equal services.

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COMPLIANCE, TECHNOLOGY AND RISK MANAGEMENT IN SUPPLYING PROCESS

Much has been discussed about compliance. “Broadly Regarding the activities, it should be covered the speaking, it means ‘conformity’, and can be applied assistance, intermediary activities, such as contracting to many subjects. In the Health Sector, for example, and service providers, purchases of products, etc. much is said about adherence to technical standards, Add to this the great evolution of the interactions more related to quality and safety standards. (...) In a that are increasingly based on technology. This is a strict sense, compliance is related to anti-corruption big challenge. rules, and has evolved to cover several other issues, such as anticompetitive practices, equity laundering In this context, focusing on supply processes, the and concealment, use of insider information in panel “Compliance, technology and risk management capital markets, etc”. in the supply process” proposes to discuss:

Therefore, with compliance, we must pay attention • The compliance challenges in the interaction of to the many stakeholders, activities and interactions stakeholders in the supply chain of the health that make up the value chain in health, always area; having the patient as the main focus. Focusing on • the role of technology in this scenario; stakeholders, we can highlight physicians and other • the supply chain activities influence on health professionals; hospitals, clinics, laboratories interactions with other stakeholders; and other public and private health facilities; • the regulatory, legal and practical knowledge pharmacies and other points of sale and dispensing; dissemination in the supply chain. distributors, importers and manufacturers; centers for new technologies research and development; complementary health care providers; among others.

VANESSA ANDRINO Hospital administrator, with MBA in Information Technology. She has 20 years of experience in healthcare market and currently leads the Regulatory Governance team at Bionexo.

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PARTNERSHIP ADDRESSES PATIENT NEEDS

To be the active voice for a group and to do good things is a virtue. In this regard, Hospitalar has fulfilled its role well. This year, the fair has the theme “Patient Experience and Engagement: A Business Approach”, and puts the patient in the center, exactly RODRIGO MOREIRA where it should be. Strategy Director for Informa Exhibitions and Hospitalar’s It is impossible to go unnoticed by the small director. He responds to achievements of the sector, especially when it can the organization’s strategic planning initiatives, promote an event aimed at this client. The 26th organizational transformation projects, new business development and UBM Group M&A edition of one of the biggest events in Latin America in Brazil. He holds a MBA with emphasis in is the concretization of the patient’s importance. Finance from the Administration Foundation Institute (FIA), degree in Business Strategy from This would not be possible without the partnerships La Verne’s University, specialization in Business that Hospitalar has been weaving during this long Administration from Fundação Getúlio Vargas - journey. And one of the most precious results that São Paulo (FGV-SP), beyond other courses. come from an upstanding cooperation is the good that is promoted through it. It can be said that the partnership between Hospitalar and the Brazilian Hospitals Federation (FBH) has increasingly strengthened the segment, since both seek to fight for an adequate hospital policy, capable of attending to the Brazilian society needs.

Both have challenged adversity with achievements and are guided by the permanent goal of qualifying health care, always guided by ethics and respect for the citizens.

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CMY

| 41 13th CBH’S SPONSORS

The Baumer Division / Infection Control team will provide the public with details about the innovations that will be on display at Booth number 13 at the RUY BAUMER FBH Convention: Ultrasonic Reprocessor E0201, PHB President - Hydrogen Peroxide Sterilizer and Medixx Software.

The native electronic cycle information storage system, which dispenses the use of printers and Innovative solutions for infection prevention and allows access through any computer connected to control network, is new to the entire line. In turn, the PHB - Hydrogen Peroxide Sterilizer has a new vacuum Present in more than 4,000 hospitals in 36 countries, generation system, ensuring efficiency, low cost in Baumer has been recognized for its quality in the operation and greater security in the process. development and execution of safe and sustainable solutions since 1950. Under the motto “commitment “FBH Convention provides the industry with a rich to health”, the company offers solutions for space for debate and experience exchanges. We sterilization and infection control, surgical center, from Baumer congratulate the Federation for the orthopedics, spine, dentistry, wound treatment, video excellence in holding another edition of this meeting,” surgery and services. said Ruy Baumer, president of the company.

To disseminate the benefits of its technologies, gain more visibility and better contribute to health development, MV participates annually in dozens of PAULO MAGNUS th th President events. The 13 Brazilian Hospitals Convention (13 CBH) is among them and is not considered by the company as just one more event. As MV President Paulo Magnus says, this is the event that represents Leader in health management system the strategic meeting between the main leaders of the sector to exchange experiences and debates MV is the leader in health management system in totally focused on expanding hospital capacity, Brazil. With more than 30 years of experience, it through improvements in service qualification and offers solutions in Information Technology (IT) for processes to the patients. hospitals, clinics, operators, diagnostic imaging centers and public and private health networks. The “Through our technologies and experiences, that company’s efforts to bring technological evolution to we want to share with the entire industry, MV more than 1,500 client institutions have resulted in participates for the second time in Brazilian Hospitals important achievements. This year, MV’s Electronic Convention with the expectation of reaching out to Record, a solution that gathers data on patient care those who can help us further boost digital health and facilitates access to this data by health teams, in Brazil and continue providing innovations that was, for the fourth time, awarded the best solution ensure efficiency, agility, precision and safety to in Latin America. health services, “comments Magnus.

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operational processes of 17 healthcare operators and 30 hospitals and clinics covering more than 6.6 million individuals in the country.

Optum, through analytical skills, clinical background LUIZ RODRIGO BARROS E SILVA and technology application, helps to identify the Executive Director populations’ health risk in order to implement specific treatments and interventions, in addition to effectively engage individuals and improve health Technology and consumer engagement for greater care and outcomes, providing an increasingly positive health system efficiency experience to the patient.

Optum in Brazil, operating in the provision of services for “One of the biggest challenges for hospitals and the health management, consulting and data analysis operators in Brazil is to balance medical costs and of the population, has shown, through its expertise, individuals’ health indicators. The 13th Brazilian that the sector is able to increase its productivity, Hospitals Convention is certainly one of the most reduce errors, improve patient experience and even important events of the sector, and the expectation stimulate and empower individuals to become more is that the lectures and debates will allow a great actively involved in the care of their own health. sharing of knowledge, promote rich discussions, connect the various players, and facilitate health Optum’s services are already present in clinical and market development in Brazil, “said Luiz Rodrigo welfare programs of more than 720 companies with Barros e Silva, Optum’s interim president and Optum’s different sizes and segments and in the strategic and executive director of growth in Brazil.

Brazil and a necessary endorsement to the dialogue on hospital digitization and innovation in the sector. “At a time when these institutions need to reinvent themselves, Pixeon has spared no effort in order ARMANDO BUCHINA to be the partner that comes to mind to face the CEO challenges,” says Pixeon’s CEO Armando Buchina. “All the investments we have made in research and development, improvements and innovation put us at Pixeon confirms presence at 13th Brazilian Hospitals the forefront as the leading technology company that Convention will help institutions transform,” Buchina reaffirms.

With initiatives that drive the digitization of the In the midst of a busy year, marked by the pre-launch sector, the company endorses a debate on the of PICS, a virtual assistant prototype to aid in medical health’s future during the event, which will take place diagnosis, and for important achievements such as on August 1st and 2nd in the capital of Bahia state - the Best in Klas award and SBIS certification, Pixeon Salvador. has also strengthened its participation in events that, like the Convention, are a reference among doctors, Pixeon, one of the largest health technology entrepreneurs and market players. companies in Brazil, will participate in the 13th Brazilian Hospitals Convention (13th CBH), held this “This is our debut at CBH. We are happy to participate year in Salvador, Bahia, on August 1st and 2nd. because, besides the Convention being among the largest in the country’s sector, we will be in one of The company’s presence is an important contribution our houses in Salvador, face to face with those who to the debate on health and hospital management in make health happen in Brazil, “says Buchina.

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the Group’s social arm, projects are carried out in health, social innovation and sport areas. Since its foundation, the Institute has directly impacted more than 900,000 people.

LÍDIA ABDALLA In 2019, we will be present for the first time at the Executive president Brazilian Hospitals Convention (CBH), which will be held in Salvador, a city that has welcomed us since 2012, and brings together entrepreneurs, researchers, leaders and Reference in diagnostic medicine managers of the health area, in addition to companies that stand out in the areas of technology, innovation and The Sabin Group has 35 years dedicated to diagnostic service delivery, and that, together, provide a strategic medicine and is present in 46 cities in all regions of environment for promotion and integration. Brazil, with a team of 5.200 employees, who deliver humanized care and excellent health services to “Sabin is a service provider in the hospital chain, more than 5 million clients daily per year. contributes to the growth and strengthening of excellence in health services and has more than 30 years Sabin understands its role within the production of experience in high complexity hospital operations. We chain and is concerned with contributing to understand that this Brazilian Hospitals Convention 13th costs’ reduction in health management and in the edition will provide excellent discussions for partnerships sustainability of the sector. We also understand our construction and experience exchanges that will allow social responsibility, especially in the cities where we the expansion of the hospital capacity in every country,” are present. Therefore, through the Sabin Institute, says Lídia Abdalla, CEO of the Sabin Group.

16. “Therefore, it is a company that complies with all regulations and favors the quality of the products destined to the hospital environment. We work for the continuous evolution of our products, so that they satisfy the needs of the hospital sector, which RAFAEL FRAGA is a very specific sector”, explains the company’s Director executive, Rafael Fraga.

According to him, the partnership with Brazilian Tradition and quality in hospital furniture and equipment Hospitals Federation (FBH) for the 13th Brazilian Hospitals Convention is very important because of the Medi Saúde is a pioneering industry in furniture visibility that the event promotes, bringing together and hospital equipment, with a market experience hospital managers, institutional leaders and the major that places it among the most renowned brands in brands of the sector in a strategic space for expertise industry. The company manufactures the entire line exchange and establishment of partnerships. of hospital furniture products, from hotel to ICUs (Intensive Care Units). “We participated in the event in Goiânia, which brought a lot of visibility to company here in the Medi Saúde products are qualified, registered in region, within our state. We have a special affection the National Sanitary Surveillance Agency (Anvisa) for Bahia and we will try to expand our market there. and in Metrology, Quality and Technology National So the participation in the event is essential to Institute (Inmetro). The company has ISO 9001, ISO achieve this visibility brought by FBH, bringing the 13485 recognition seals and complies with the hospitals of Bahia state to know our products and manufacturing practices regulated by Anvisa RDC materials,” says Rafael Fraga.

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EDGAR MULLER President

Technology and innovation in health Aligned with the idea of improving the economic environment and aiming at optimizing costs, the SAMTRONIC does not stop reinventing itself. The company took a step further and will receive the company has just launched the newest generation first machines destined to automate part of its of the peristaltic infusion pump, ICATU. The available manufacturing processes, with start-up expected models, now with TFT color screen and touch for the third quarter of this year. The manufacturing keypad, are: ICATU, ICATU S, ICATU TCI and ICATU S unit of the disposable devices, located in Bragança TCI. Innovative in peristaltic infusion pumps, the Paulista-SP, covers a useful area of more than TCI (Target Control Infusion) models have several 10,000 m2. infusion protocols used in venous anesthesia. With this investment policy, SAMTRONIC shows Despite the market’s uncertainties and difficulties, its customers the certainty that they can rely on the company continues to invest heavily in order a company that, for more than 32 years, has been to ensure its business expansion and maintain its attending to demands uninterruptedly, providing leadership in the infusion pump market. Recently, high quality products of great relevance to the pressured by rising demand for its disposable national and international market. medical device lines, it has shifted the address of its distribution and logistics center to a new location To conclude the formula of its recent commercial that has doubled the floor area (6,000m2). Fully partnerships, SAMTRONIC has added new equipment, adapted to the company’s strategic plan, these new such as: cardioversors, DEA (automatic external facilities provide greater operational gains between defibrillator) and ECG (echocardiograph). It also plants, suppliers and customers. innovated its product line, bringing to the market SAFESAM® needle-free valve connectors and high Believing in the economy’s improvement and betting precision syringes of SERISAM® line, certified by on the future, this year SAMTRONIC will also double Inmetro for use in infusion pumps, with different the productive area dedicated to disposable products applications for use: enteral nutrition (purple), assembly, considerably expanding its capacity to photosensitive parenteral solutions (amber) and meet the national market’s expectations and exports. various parenteral solutions (crystal).

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YUSSIF ALI MERE JUNIOR President

For the qualification of Dialysis and Transplant Centers FBH acts in a permanent and articulated way, close to public agencies, seeking better working conditions The Brazilian Association of Dialysis and Transplant and improved care for its patients. Abimo is always Centers (ABCDT) support the partnership between working to promote the sustainable growth of the the Brazilian Association of Medical, Dental, Brazilian hospital industry. Without a doubt, this Hospital and Laboratory Equipment (Abimo) and the partnership in the 13th Brazilian Hospital Convention Brazilian Hospitals Federation (FBH), considering (13th CBH), which will take place in Salvador-BA, on it to be extremely important for the hospital sector August 1st and 2nd, 2019, will be very innovative and representativeness in Brazil. will bring forth progress for the Health Sector.

EMERSON DA SILVA President

A Partnership to Boost Health! activating business and projects in a collaborative way, co-creating with people of any profession, area With 25 years of institutional experience, the Brazilian of knowledge and culture, in a diverse, creative and Association for the Development of the Hospital innovative network with common values to undertake Building (ABDEH), in this 2017-2020 management, and transform the world. has, as its main purpose, to connect! Connecting People to Communities ... Business Ideas ... Problems We believe that a better world is created through to Solve ... Transforming Communities into Crowds! the joint accomplishments of creative, committed and passionate individuals who are focused on a At the apex of the creative economy, where the ability common purpose: to promote health in the spaces to innovate, generate ideas and original solutions they idealize! has become an important market asset, connectivity becomes indispensable, something that is far beyond We understand that effective participation in 13th sharing. If we want to be innovative, we need to be Brazilian Hospitals Convention (13th CBH) is the agile, integrative and collaborative. opportune moment to promote connections and boost knowledge diversity. A multiplicity of visions We want to integrate this global network of in search of the same ideal: to broaden our health connected communities, with the objective of care understanding!

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PAULO HENRIQUE FRACCARO Superintendet

The representativeness of the industrial health park Representing the health industry, Abimo gains even more strength by having the opportunity to be Health is one of the most strategic sectors of alongside robust entities of the sector such as the the Brazilian economy, therefore the quest for Brazilian Hospitals Federation (FBH). Thinking about sustainability and growth is constant. Its productive the present and planning the future, the Association chain, every day, invests more in research, understands that hospital demands are changing development and innovation, in order to generate due to technological development, and finds in the highly technological solutions to remedy the partnership with FBH the chance to consolidate itself as obstacles of the system. With an indispensable role for an interesting bridge between the producers of these the development of the sector - including in relation technologies and the users of the hospital network. to national public health - the Brazilian Association of Medical, Dental, Hospital and Laboratory Equipment In a 4.0 world, where innovation is gaining more and (Abimo) tries to obtain, in relation to the main entities more notoriety, to be able to count on an event of of the segment, an interaction capable of improving the magnitude of Brazilian Hospitals Convention the management, efficiency and productivity (CBH), which brings light to the main strategies and expected by the country. opportunities of this segment, is gratifying.

It also acts as a representation instrument of its members, aiming at the defense of the rights and prerogatives of an institutional nature. It cooperates with health and education agencies and entities, with a view to achieving its objectives. Aware of the reality ROBERTO SÁ MENEZES of the Unified Health System (SUS) underfunding, President Abrahue has repeatedly strengthened discussion spaces with Health Ministries (MS), Education (MEC), Science and Technology (MCT) and the Brazilian Company of Hospital Services (EBSERH), in order For excellence in the training of health professionals to discuss the current challenges faced by these hospitals and strategies for strengthening teaching The Brazilian Association of University and Academic and research, as well as ensuring sustainability Hospitals (Abrahue) is a non-profit civil society and qualified care in the country’s university and with legal personality under private law, which academic hospitals. congregates academic hospitals. Founded 30 years ago, its purpose is to look after its members’ interests, Abrahue’s partnership with Brazilian Hospitals representing them in terms of a common goal with the Federation (FBH), especially during the 13th Brazilian public authorities at the federal, state and municipal Hospitals Convention (13th CBH), promotes the levels and before other national and international valuable strategic meeting between managers in the associations and institutions, with actions for the area to discuss partnerships and experiences that development of excellence in teaching, research, contribute to the qualified training of professionals care and management. to perform with excellence in hospitals.

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PRISCILLA FRANKLIM MARTINS Executive Director

Representativeness of Diagnostic Medicine in Brazil the 4th International Health Leadership Forum, which will bring together more than 500 leaders The Brazilian Association of Diagnostic Medicine and authorities to discuss the sector’s strategies, (Abramed) has been increasing its representativeness sustainability, regulatory issues and perspectives. in the health market throughout the year. Nowadays, after much effort, the entity has a common vision, a At the same time that we receive our partners in union, and congregates companies of all sizes that our events, we are always close to them in their represent more than 50% of the volume of diagnoses congresses. And it is great to be at the Brazilian performed in supplemental health. Hospitals Federation (FBH) side to hold the 13th Brazilian Hospital Convention (13th CBH) to discuss We are focused on jointly addressing this segment improvements in health management. challenges and, to that end, we are working towards

REINALDO DE CAMARGO SCHEIBE President

Professionalism, efficiency and quality of services

In these more than 50 years operating in the market, maintaining 6,5 million direct and indirect jobs and the Brazilian Association of Health Plans (Abramge) more than 1.5 billion procedures - which greatly has been promoting professionalism, efficiency and contributes to medical care evolution in Brazil. quality of health services. Abramge represents group medicines, a modality that has its origin directly The partnership between Brazilian Hospitals Federation linked to hospitals and medical centers of its own, (FBH) and Abramge is fundamental for supplementary and covers one-third of the health plan beneficiaries health. This union strengthens the sector, making in Brazil, approximately 25 million people. possible the analysis and operationalization of solutions that seeks to contribute to our population’s With a focus in the quality of the services and with health, such as the search for a remuneration model the permanent goal of stimulating excellent provision centered on the clinical outcome of the patient. of services to millions of health plan beneficiaries, Together we are stronger. Together, we work for the Abramge reinforces its commitment to improve country’s health system continuous improvement, supplementary health, a segment responsible for always hoping for a better Brazil.

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LEANDRO FONSECA DA SILVA Chief Executive Officer

Sector must deliver more value-based health services for the National Supplementary Health Agency (ANS) and is undoubtedly one of the main challenges of The delivery of health outcomes that matter to the the sector. It is about time to change this scenario patient at a cost that is affordable for those who have and hospital institutions engagement is fundamental health insurance should be the objective of those for creating a new age. No new laws or government who work in the value chain of supplemental health determinations are needed to change the status quo. care. The competition pattern among operators, Sectoral leadership, especially in hospital segments, therefore, should focus on delivery of value-based can promote the gradual process for improving the health services. To that end, the model of care must be quality of the sector, measuring and disseminating reorganized, focusing on prevention and promoting their health outcomes. an organization of services in an integrated way, within the whole cycle of care that is necessary for the The supplementary health sector evolution requires health of the beneficiary. The lack of coordination of actions of all those who work in it. In ANS case, we the care damages life quality and wastes resources, will seek to improve the inductive regulation in order which compromises the sustainability of the sector. to have an industry that is delivering better health outcomes, with quality and at an affordable cost. The induction for the sector to promote better health outcomes in a sustainable manner has been a priority

municipalities, from the five regions of the country, with a total of 3,169 registers.

The CFF established this partnership with the Brazilian Hospitals Federation (FBH) for believing in the work th WALTER DA SILVA JORGE JOÃO developed by this entity and believing that the 13 President Brazilian Hospitals Convention (13th CBH) will be a virtuous moment for the event’s makers and participants, who will join their efforts to bring improvements for the hospital sector and its professionals. The Federal Pharmacy Council (CFF) has been working constantly to expand the pharmacist role in The theme of this edition is timely, as it seeks the hospital area. Since 2015, we have reached all to leverage strategies necessary to face today’s the states of the country with a project coordinated challenges, as well as to establish partnerships and by our Working Group on Hospital Pharmacy. More promising experience exchanges so that Brazilian than 1,500 pharmacists completed the specialization hospitals continue to evolve, as these advances course. We also offer the Pharmaceutical Care Project reflect in a greater capacity to provide care, and is at SUS, which has been transforming the scenario by advancing together, in search of solutions for of basic health units where it was implanted. The health, that we can bring more and more quality to initiative has already involved pharmacists from 360 the patients.

| 49 13th CBH’S SUPPORTERS

countless victories for the philanthropic health sector, consolidating itself as the main spokesperson for the segment. Throughout its 56 years, the entity has EDSON ROGATTI grown and strengthened its institutional relations, President becoming the sector’s largest representative in the Executive, Legislative and Judiciary, as well as in the movements on behalf of the segment, articulating Representativeness of Philanthropic Hospitals with deputies, senators, Civil House, Republic Presidency, among other leaderships, presenting The Holy Houses of Mercy, Hospitals and Philanthropic pleas and demanding solutions, especially regarding Entities Confederation is a non-profit association health improvement and health sustainability. created in 1963 to promote the union, integration and development of the institutions it represents and In this context, just over 20 years ago, a solid CMB thus maintain the quality of care and well-being of / FBH partnership was established for all themes of the population. It is the highest representative body common interest of its members, especially in the of the Holy Houses, Entities and Beneficent Hospitals Deputies Chamber, Federal Senate, Health Ministry in Brazil, which now account for more than 51% of and regulatory agencies. Over the years it has the Unified Health System (SUS) and almost 70% of established itself as a very successful partnership, the services of medium and high complexity. with numerous benefits provided for the associated hospitals. The alignment and defense of important Comprised by 16 state-owned federations and issues for the nation and for hospitals are important headquartered in Brasília-DF, CMB has achieved strategies to guide the work of CMB and FBH.

reform and more than 450 law projects with a direct impact on the sector. We cannot forget the hearings that have been held to discuss the updating of the values of the SUS Table, which will certainly alleviate the insured services to the SUS.

BRENO DE FIGUEIREDO MONTEIRO The Brazilian Hospitals Federation partnership in President these debates and meetings and the union of entities around the same goal contributes even more to the development of the Health Sector. A highlight of this The National Health Confederation (CNSaúde) has partnership is the study “Hospitals in Brazil” which been active in causes that benefit the Brazilian is in its second edition and shows the reality of the Health Sector, especially healthcare providers, not to situation of private and non-profit hospitals in Brazil, mention society in general. leading to discussions about the number of beds in the establishments and their distribution in the country. CNSaúde has effectively participated in important discussions in the Deputies Chamber and in the To participate and to assist in the promotion of the Senate. The Pension Reform is one of the examples, 13th Brazilian Hospital Convention (13th CBH) is an which we are in favor of changes, because we believe honor and is also a way to seek solutions to the that only with this reform the country will build challenges that the sector is facing today and also to momentum for an economic recovery, besides the tax discuss innovations for the health development.

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Thinking about the professional valorization and in the search for the rights of the category, the Federal Nursing Council (Cofen), in partnership with the World Health Organization (WHO), launched MANOEL NERI the Nursing Now campaign in April. The campaign President draws the attention of authorities to recognize these professionals, essential to achieve global, national and local health goals. To fight for a recognized Nursing is our mission Our achievements reflect the joint work of the Cofen Nursing, like no other category, has the essence of System / Regional Councils, which seeks to rescue caring for the other. It is the one who is at the forefront the dignity, protagonism and recognition of Nursing, of patient care. And, through complex procedures, in addition to providing a quality service to the save lives, rebuild trajectories, and change realities Brazilian population. every day. The 13th Brazilian Hospital Convention (13th CBH) will Annually, we commemorate the Nursing Week from provide an important meeting among leaders of the May 10th to 20th, in honor of two nurses (Florence Health Sector, who will seek to discuss and innovate Nightingale and Anna Nery) who became a milestone the hospital area, promoting the construction of a in the work carried out in the Crimean War and better patient care. Cofen, as an organ of regulation, Paraguay, due to the direct care of wounded soldiers supervision and discipline of the professional practice and of the population. of Nursing, is proud to be part of this process.

We intend to continue advancing in the defense of the SUS, reinforcing its guidelines. Conasems, always very transparent and ethical, approached companies that are directly related to SUS and the municipalities MAURO JUNQUEIRA in order to help us foster projects that promote President improvements in the health of the population. With “Novo Nordisk”, for example, we promote diabetes- related actions. I believe that the approximation between the municipal public management and In defense of SUS improvement the productive health chain presents itself as a strengthening opportunity in overcoming the current The Municipal Health Secretariat National Council challenges of public health in Brazil. has expanded its role in defending and maintaining the right to health, aiming at training the municipal The underfunding of the SUS is, in particular, a health manager to provide increasingly efficient challenge that I always approach in meetings, services. In the last year we had the Basic Attention appointments and lectures because it is, in fact, a National Policy (PNAB) approval, with innumerable theme we have been discussing since the system’s developments for the manager’s work, which reflects creation. The constitutional amendment 95 (EC) on the life of the citizen that benefit from the Unified makes the sustainability scenario of SUS a daily Health System. The PNAB brought new arrangements challenge to the manager. Together, we want to for the Family Health teams and was an immense improve the management and services provided to achievement for the 5,570 municipalities in Brazil, the population, and for this, more than ever, adequate which have many different realities. financing of the system is needed.

| 51 13th CBH’S SUPPORTERS

networking through various resources. In addition to exhibiting products and companies, HospitalMed invests in digital marketing, which connects exhibitors to consumers all year round, in more than 150 hours of parallel content, including lectures, congresses RODRIGO DA FONTE and symposia. President The inclusion of the Iconne and the 24th Copeo fairs are also innovations, specialized events in the dentistry The largest and most complete North and Nor- sector in the HospitalMed 2019 pavilion, offering theast health fair even more opportunities to exchange experiences.

HospitalMed is the largest and most complete North and Brazilian Hospitals Federation (FBH) and HospitalMed Northeast health fair, which brings together the entire have a partnership and a steady relationship since Health Sector production chain of the region. Annually, the fair’s first edition, held in 2013. The work there is a grand meeting of suppliers of products, of connecting professionals and health market services, equipment, technology and content for health industries for the well-being of the whole country is centers, such as hospitals, laboratories, pharmacies, noteworthy. The 13th Brazilian Hospital Convention clinics, medical practices and professionals. (13th CBH) will cover important and innovative topics for the health market, and the meeting is confirmed In its 7th edition, the fair returns, providing innovative for August 1st and 2nd, in Salvador/Bahia. HospitalMed and unprecedented opportunities for business and wishes success to the event and to the organizers!

LUÍS CLÁUDIO RODRIGUES MARROCHI President

As the only national entity representing the home Initiated last year, the partnership between NEAD care companies, the Núcleo Nacional das Empresas and Brazilian Hospitals Federation (FBH) is becoming de Serviços de Atenção Domiciliar (NEAD) (National increasingly necessary and special. After all, shifting Center for Home Care Services) has been working for the population’s profile requires increasing integration 16 years to disseminate this particular concept of care, among all links in the health chain, so that it is possible which is increasingly fundamental to Brazilian health to provide quality, humanized and patient-focused care care system sustainability, as well as tirelessly seeking that are the aspirations of every society. its regulation alongside the competent agencies. In this sense, 13th Brazilian Hospitals Convention (13th Privileging people’s training and improvement, structures CBH) will be, once more, an excellent opportunity for and institutions to provide management and assistance, integration between hospitals and home care, since NEAD develops actions and instruments to establish the representative entities can once again aggregate standards and minimum quality criteria. There are among knowledge and efforts to improve the health sector in these the events and publications that are references in the country. We hope that the event is a success and the market for technical-scientific-educational and are that we can contribute so that it is also innovative! always considering the demands of all stakeholders.

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CLÁUDIO JOSÉ ALLGAYER President

National standard of security and health quality services, home care, haemotherapy, nephrology and renal therapy, hyperbaric medicine, oncology, On June 1st, the National Accreditation Organization imaging diagnosis, radiotherapy and nuclear (NAO) completed 20 years of hard work as the medicine, dentistry clinics, clothing processing for main responsible for the development of national health services, sterilization and reprocessing of standards of safety and health quality in Brazil. materials, diet therapy and manipulation, as well as programs for health and risk prevention. Certifying the health services quality with a focus on the patient safety, NAO is recognized by ISQua 13th Brazilian Hospital Convention (13th CBH) is an (International Society for Quality in Health Care), a event of great importance for the Health Sector in partner association of the World Health Organization Brazil and it is a great honor to build this innovative (WHO) that has representatives from academic convention with Brazilian Hospitals Federation institutions and organizations in more than 100 (FBH), focusing in management, in attendance and countries. There are already more than 2,500 in the results, bringing together the most important certifications made in Brazil and, currently, more than Brazilian professionals from the sector. 800 organizations with valid certification. There are more than 20 years of partnership with Therefore, NAO has consolidated itself as the main the FBH, one of the founding entities of NAO and a accreditation methodology for health in the country, member of the Board of Directors even today. NAO and one of the largest in the world, evaluating more congratulates FBH’s initiative to strengthen the sector, than 16 different types of health services, such as: especially because it is always trying to improve the hospitals, outpatient clinics, laboratories, emergency qualification and service of health services in Brazil.

| 53 PERMANENT EDUCATION

LEADERSHIP, PROFESSIONAL QUALIFICATION AND SUSTAINABILITY ARE TOPICS OF THE DEBATE PROMOTED BY AHSEB

What is the true essence of health organizations? “In our health segment, we have an economic How to achieve sustainable results in hospital representation in the market that equals 10% of management? These were the questions that the entire national gross domestic product (GDP). permeated the debates promoted by Bahia State Any health service imposes two basic requirements: Hospitals and Health Services Association (AHSEB) intense labor and extremely skilled labor. So we in a meeting that addressed the importance of reflected on this, we evaluated that it would be worth qualification of human work in the care provided not just one or two lectures on the subject, but a by hospitals and health centers. The event was whole event on the subject, addressing success cases held last April 24th at the World Plaza Business and experiences in people management,” explained Center in Salvador, Bahia, and was attended by an AHSEB President Mauro Adan. auditorium filled with dozens of technicians and hospital managers.

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According to him, the meeting proposal was to discuss strategies of how to engage health professionals within an organizational project, to awaken leadership in the work environment, and to provide a secure path to achieve sustainable results for the organization.

Leonardo Gigliotti Barberes, Brazilian Hospitals Federation (FBH) Fiscal Council member, was invited to join the solemn opening table of the event, highlighting the technological advancement scenario that humanity is experiencing, and finds, in the Health Sector, an emblematic example. For him, this technological evolution is useless if it is not accompanied by human qualification.

“The technological incorporation in health is a reality that increasingly finds spaces in the sector, in fact within our lives as a whole. However, we must never forget that the true differential in obtaining results is in the professional’s performance. Human capital, without a doubt, is the greatest asset of an institution, and certainly the most positive results are linked to it, since health care still needs people who treat people. And that is one of this meeting objectives, to discuss the leadership, how to motivate the workers, how to make them act in the best way towards the qualification of the service, “stressed Leonardo Barberes.

SPEECHES The meeting’s agenda included four lectures on various topics, such as “The secret of the best companies to work for” and “Internal communication: image’s reflection and health institution results”. The lecture “Using the skills of every team to achieve high performance”, promoted by the directors of the Brazilian Institute for Health Excellence (IBES), Christian Hart and Rafael Munerato, and Santa Izabel Hospital’s technical director, Ricardo Madureira, was one of the greatest debate moments during the meeting. The directors presented the discussion about leadership and engagement importance of the entire team in the production process and in the achievement of positive results for the health unit.

Felipe Nabuco Photos: Edson Ruiz [email protected]

| 55 PREVENTION

BRONCHIOLITIS: ARRIVAL OF COLD INCREASE CASES OF DISEASE IN PREMATURE BABIES

MAIN CAUSE OF HOSPITALIZATIONS DURING THE WINTER, PULMONARY INFLAMMATION IS MORE COMMON IN PREMATURE INFANTS AND CHILDREN UP TO 2 YEARS OF AGE

Symptoms resemble those of a common cold: should be used in these risk groups during the coughing, wheezing, breathless, fever, and trouble to winter, when the virus that causes bronchiolitis is in feed. But bronchiolitis is more persistent, affecting increased circulation,” said the pediatrician. mainly young children and, if not treated properly, can lead to complications. “It is the main cause of There are up to five doses with 30-day intervals whose hospitalization of patients under 2 years of age during main objective is to reinforce children’s immunity that the winter due to dehydration, respiratory failure are more susceptible to RSV. In Santa Cruz Hospital’s and pneumonia,” explains the Santa Cruz Hospital NICU, all premature babies receive the medicine and Neonatal Intensive Care Unit (NICU) pediatrician and are closely monitored by the multidisciplinary team coordinator, Curitiba (PR), Ênio Luis Torricillas. to prevent and, when necessary, treat the disease effectively and quickly. Bronchiolitis is an inflammation caused by the Respiratory Syncytial Virus (RSV) and reaches the ABOUT SANTA CRUZ HOSPITAL lungs’ finer branches, the bronchioles. The disease Founded in 1966, Santa Cruz Hospital is located in causes swelling and accumulation of mucus in these Batel neighborhood, in Curitiba (PR). Considered small structures, which hinders air passage. “About an excellence center in high complexity in 90% of children have contact with the virus until Oncology, Cardiology, General Surgery, Neurology, they are 3 years old, and most have mild symptoms. Orthopedics, Ready Care, Checkup and Maternity In these cases, the treatment is only symptomatic, but areas, it is a reference in Curitiba. It offers a more severe conditions require hospitalization and privileged structure, multidisciplinary team, state- follow-up of a specialist, especially when bronchiolitis of-the-art equipment and a modern surgical center, occurs in premature babies,” explains Enio. being a reference in the hotel service and in humanized care, with assistance quality and focus PREVENTION on patient safety. Recognized with the Accreditation Babies born less than 28 weeks old and children up to with Excellence stamp, the national certification 2 years of age who have chronic lung disease or heart highest level awarded by the National Accreditation disease need to be preventively medicated. “The Organization (NAO), is the institution accredited in monoclonal antibody, a drug known as Palivizumab, this category for the longest time in Paraná

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| 57 ETHICS AND COMPLIANCE

COMPLIANCE AND THE CONSTANT HEALTH EVOLUTION

segments, which exposes everyone to a gigantic RICARDO RAMIRES FILHO network of norms and rules that must be observed Lawyer, a Dagoberto Advogados member, and followed. Perhaps, what makes the health area specialized and post-graduated in Business Law so instigating and challenging within this context of in health area, a member of the Committee on creation and compliance area development is the fact Studies on Health Plans and Medical Assistance that, at the end of service provision, it is the greater and coordinator of the Study Committee on good of a human being (so we believe): your health. Home Care of the Organization of the Lawyers of Brazil - São Paulo Unit (OAB / SP). He also Patients, doctors, hospitals, health insurance attended Private Health Systems and Reform companies, laboratories, the pharmaceutical industry, of the American Health System by the Harvard among others, are actors in a film that has being seen School of Public Health. and reviewed every day, throughout society, and is criticized and praised (perhaps more critics), but CLÁUDIO CARNEIRO where everyone believes that it is still possible to Legal advisor to Dagoberto Advogados, create a more balanced and effective system, and we especially for compliance implementation. believe that the compliance area can play a relevant role in the search for this system.

There are many hypotheses in which we can highlight The development of a regulatory state coupled with the compliance role in value generation or risk the growing evolution of business corporations has management in the health segment, but only for the brought to debate the importance and prominence sake of illustration and based on the information that the compliance area has been gaining within made public by the periodicals available to everyone, these corporations, be it small, medium or large, we bring the issue involving the disclosure in a seeking the risk management and compliance with group restricted to medical professionals, in an the rules and regulations that impact their business. instant chat application, where the professional, And it is with absolute conviction that we affirm that even before public disclosure, sent test results to the Health Sector - seen here as the whole system - exchange clinical opinions without authorization is one of the sectors that most needs to create and from the family or from the hospital to which it was develop a strong and active compliance area to assist associated, in discordance to the subject regulation the business development, besides aggregating or the conduct code of the institution. value to the segment, as we shall see later. After an internal investigation of the hospital The Health Sector has as one of its main characteristics unit, it was decided to dismiss the professional for the multiprofessional interaction in the development justified reasons, which, respecting the decision in of its activities, with professionals from diverse question, brings to the debate the whole process of segments and with various rules in each of these risk management developed in health institutions,

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since we understand that among the pillars of a health’s segment, helping its development and good compliance program lies, for example: (a) top seeking, each day, a quality health to people who management involvement; (b) conduct codes; (c) use the private and public systems, never forgetting constant training; (d) complaint channels, etc. The that the most important actor in this trajectory will item related to the monitoring and training of the always be the human being, the main objective of the professionals involved could have greatly mitigated scenario presented here. the exposure of everyone involved: patient, medical professional and institution.

Experience shows that the resistance that prevailed over many years among Health Sector professionals and companies in terms of knowledge and monitoring of the risks involved in their activities has given rise to the correct perception that a broad and well- planned compliance program protects everyone from possible damage arising from non-compliance with the rules, since the constant training and the involvement of everyone in the creation of a policy with a full knowledge of the risks inherent to these Experience shows that the activities - from the preventive point of view - allow a quick instructive and corrective action on the doubts resistance that prevailed over brought to the analysis to the compliance sector. many years among Health Sector It is also important to highlight that the broad knowledge of the norms and rules that operate in the Health segment, in which the regulatory nature professionals and companies in is very present, either through regulatory agencies or by professionals working class’ entities in this terms of knowledge and risks segment, or even the legal norms that also have effects in this system, is a fundamental factor for monitoring involved in their the creation and development of an active and respected compliance area. activities has given rise to the Finally, but no less important than the guiding and corrective role of the compliance area, we have the correct perception that a broad clear vision that any actor in this system who will undergo a merger and acquisition (M&A) process and well-planned compliance during its course will have important financial benefits if they maintain a compliance area in its administrative structure, as this will show, quickly program protects everyone from and safely, to those involved in the process, respect for the people and for the rules involved in its possible damages arising from business development, including in determination of any existing liabilities, mainly those not non-compliance with the rules.” accounted for, effectively bringing financial value to your service or product.

It is with this look of attention to the sector’s norms and rules that we intend to continue analyzing the

| 59 DIGITAL HEALTH

THREE IMPACTS OF DIGITAL TRANSFORMATION IN THE HEALTH SECTOR

Long queues, inadequate services and facilities that do queues, negligence risks and even operational costs. not inspire confidence. This is the biggest nightmare The new flow provides agility in service and reflects for health institutions. Hospitals, laboratories and directly on the service quality. clinics begin to invest in their clients’ comfort, applying technologies to improve the service, be it in agility or 2) ELECTRONIC PATIENT RECORD in the patient’s well-being. Digital data storage provides many benefits to a healthcare institution. Eliminating paper not only Digital transformation arose to implement new favors the environment, but also reduces the need for trends. Get to know three of its main applications: physical space and human errors, such as changing wristbands, losing files, and so on. However, this is 1) SELF-SERVICE TOTEM not the prominence point. This application can be used in patient entry registry, facilitating internal guidance, as well as assisting Data consolidation streamlines the information flow with information about facilities and payments for within hospital facilities as it provides an overview services. The use of these electronic terminals reduces of the patient’s history. Such a solution generates a

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Currently, in Health area, it is not just about offering quality treatments. Paying attention to the client’s journey within the facility, from the moment he arrives to the moment he leaves, is crucial to the institution’s success.”

large database and the possibility of using “machine Nowadays, it is possible to find online no-breaks learning” and “deep learning” techniques, which that provide high quality power and that can be can contribute to rapid disease diagnosis trends managed remotely, having sizes compatible with and development, information analysis from several the available space. patients, and identification of public health problems. The software is used not only for management but 3) RADIO FREQUENCY IDENTIFICATION also for failure prediction and is already a reality, as LABELS (RFID) Schneider Electric offers, with Galaxy VS integrated The safety of the most vulnerable people, such as with the EcoStruxure IT. In addition, to reduce further children, the elderly or patients with some mental the space occupied by this type of system and pathology, is also an attention point in health the maintenance cost, it is possible to use lithium environments. With that in mind, a solution with batteries, which have a size 60% lower than those of radio frequency identification (RFID) tags can locate valve regulated lead-acid battery (VRLA) and require these patients inside institutions. Labels can also fewer replacements over time. be used for traceability and equipment registration, Currently, in Health area, it is not just about which contributes to the reduction of expenses due offering quality treatments. Paying attention to to the accumulation or loss of hospital assets. the client’s journey within the facility, from the ENERGY ISSUES moment it arrives to the moment it leaves, is crucial to the institution’s success. Investing in patient All innovations cited so far depend on a safe and comfort and safety ensures a high satisfaction rate, available electrical power source. There is no point in generating a positive reputation. improving service efficiency if they can fail in the first electricity surge. In this context, new technologies can be implemented to protect all equipment, such as “no-breaks”.

For the sake of patient safety, the use of no-breaks in anesthesia rooms, surgery rooms and Intensive Care Units (ICUs) are essential. However, we can ALAN SATUDIE increase protection range for other critical systems Electrical engineer in training and product located in hospitals. marketing manager for Schneider Electric Brazil.

| 61 ALTERNATIVE PLATFORM

PLATFORM BECOMES AN ALTERNATIVE TO SUS AND HEALTH PLANS

DANDELIN IS A SHARING-ECONOMY QUERY SCHEDULING APPLICATION

According to the National Supplemental Health “Our service does not have bureaucracies and Agency (ANS), more than 3 million Brazilians does not limit the number of consultations,” said abandoned their health plans in the three-year Felipe Burattini, Dandelin’s CEO. “If the monthly fee period, due to the readjustments. In addition, the exceeds R$ 100 (around US$ 26,00), we will bear Health Ministry indicates that the Unified Health the costs.” System (SUS) attends more than 160 million people, and the delay in getting an appointment The service is becoming increasingly used due to with a specialist can reach up to 12 months by these features and the more people are on the the system. platform, the lower the price charged.

As an alternative for people who do not have health ABOUT DANDELIN plans and do not want to depend on SUS, there are Developed based on sharing economy principles, some platforms that offer medical consultations at Dandelin is an application that connects patients to an affordable price. An example is Dandelin, a health physicians. The platform facilitates the consultations’ application that seeks to schedule consultations scheduling, which are performed in the offices of the based on sharing-economy, socializing costs among professionals registered. Thus, the patient can seek all members of its community. doctors by location, specialty, schedule availability, symptoms or by the professional’s own name. The app was created to provide simple, fair and humane access to medical services. With the The platform socializes actual consultations costs application, users do not pay the query’s price, but among all members of its community. The average a variable monthly fee, which will never exceed monthly amount for unlimited access to medical R$ 100,00, divided evenly between all parties. appointments is variable and depends on the The final value does not have additional costs or inquiries number that community members make readjustments above inflation, which democratizes during each month but never exceed R$ 100,00 access to quality health. (around US$ 26,00).

62 | HOSPITAL’S DAY REVISTA VISÃO HOSPITALAR

FBH HONORS THE MORE OF 4 THOUSAND HOSPITALS IN THE COUNTRY

Attention, trust and respect. These are feelings which diagnosis and therapy; quality in hotel services, food, generally permeate the relationship between patients biosafety and hygiene; management and information; and health professionals working in a hospital unit. Among other things. A relationship that builds family references, which comes to mark lives and eternalize moments. This degree of requirement to maintain qualified services and the need to work with technology to This Tuesday (07/02) is celebrated the Hospital ensure safety and precision is what makes hospital Day, a date that recognizes the importance of this services so costly today. Faced with economic crisis valuable equipment for mankind history and for the scenarios that Brazil has been going through over the development of today’s societies. decades, guaranteeing the full functioning of these health centers throughout Brazil is a challenge that The history of the first hospitals in Brazil is confused puts the future of our society in check. with the country’s history itself. The Hospital Day is celebrated on July 2nd in honor of the solemnity The Brazilian Hospitals Federation (FBH), a pioneer held in 1945, with the presence of the then President in the private hospitals defense in Brazil, has been of the Republic, Getúlio Vargas, who marked the involved in major struggles for better remuneration Santos Mercy’s Holy House’s new headquarters for hospital services and for a tax policy that offers inauguration. Built in 1543, just four decades after adequate operating conditions to the 4,267 private the arrival of the first Portuguese caravels, Santa Casa hospitals that exist today in Brazil. is the oldest hospital in operation in the country. According to FBH’s president, Adelvânio Francisco Over the centuries, the hospitals evolution in Brazil Morato, the scenario shows today that the hospitals has been following the cities evolution, sciences and fight is for survival, especially of those of small and society. When they become establishments aimed at medium size, who are the only door of entry for saving lives, hospitals have increasingly demanded the population in need of assistance outside large qualification on all fronts: a highly specialized urban centers. workforce; great technological density equipment or

| 63 HEALTH AND ECONOMY

HOSPITALAR 2019 CONSOLIDATES ITSELF AS THE LARGEST HEALTH EVENT IN THE SOUTHERN HEMISPHERE

THE LARGEST LATIN AMERICAN HEALTH FAIR AND FORUM PRESENTED MORE THAN 1,200 EXHIBITING BRANDS AND 40 SIMULTANEOUS CONGRESSES THIS YEAR. ABOUT 40 THOUSAND VISITORS WERE PRESENT DURING THE FOUR DAYS OF MEETING.

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For four days, from May 21st to 24th, the entire mentioning that Brazil has the third largest assistive world turned their attention to São Paulo (SP) city, technology industry in the world, with room for both which became the Latin American capital of health. domestic and foreign market growth. Hospitalar 26th edition, considered the largest Health Fair and Forum of the Southern Hemisphere, “Also reinforcing the exhibition area and expanding was officially opened with the presence of the the participation of themes related to home care, largest leaders of the sector in Brazil. The Brazilian the ‘Home Care space: transition and continuity of Hospitals Federation (FBH) president, Adelvânio care’, in partnership with EnCONSAD, brought a new Francisco Morato, honored the opening ceremony dimension within the event, which featured free and highlighted the importance of the event. lectures, courses, case presentations and areas with adult and pediatric home beds. The objective was to “This is the main meeting between the actors show the new perspectives for business and services who build a future for health in Brazil. A unique that tend to contribute by improving excellence in opportunity to update knowledge, expand their home care processes,” explains Rodrigo Moreira, network of relationships and have access to what is Strategy Director of the Informa Exhibitions and most innovative in the health market,” said Morato. Hospitalar’s director.

Thousands of technicians and professionals in health areas, technology, innovation and hospital management from all over Brazil, as well as representatives from 50 countries, were gathered at the Expo Center Norte in São Paulo, Brazil, to share knowledge, exchange experiences and promote business with the latest info in health market. The event had a wide program, which presented 1,200 exhibiting brands, 40 simultaneous multidisciplinary events and more than 200 hours of content. Health is a sector of immense Waleska Santos, Hospitalar’s president and founder, highlighted during the opening ceremony the event’s importance, which promotes visibility and importance for social welfare, but recognition of brands and contents. “Health is a sector of immense importance for social welfare, but also for any country’s economy. also for any country’s economy. During those years, boldness and innovation have been the Hospitalar’s During those years, boldness main brands,” she said. and innovation have been the Focused on priority themes for the health agenda, the Fair brought to this year’s edition a subject that reflects the market’s new direction: “Patient Hospitalar’s main brands,” Experience and Engagement: A Business Approach”. For this, Hospitalar provided an entire pavilion – Waleska Santos - Hospitalar’s dedicated to the content of rehabilitation, with a congress focused on this very theme. It is worth president and founder

Felipe Nabuco [email protected]

| 65 HOSPITALAR 2019

FBH PRESENTS UNPUBLISHED STUDIES ON HOSPITAL MANAGEMENT IN BRAZIL

LAUNCH OF THE BOOKS “HOSPITAL SCENARIO IN BRAZIL 2019” AND “HOSPITAL MANAGER’S MANUAL” HAPPENED DURING THE LARGEST HEALTH FAIR IN LATIN AMERICA

Felipe Nabuco [email protected] Brazilian Hospitals Federation (FBH) is promoting this year the launch of two important publications, which are true contributions to the supplementary health improvement in the country. The first, awaited The ceremony was launched during Hospitalar’s with great expectation by hospital administrators, 26th edition, considered the largest Latin American is the “Hospital Manager’s Manual”, work organized Health Fair and Forum, and was attended by the main with multidisciplinary contribution of authors from national health leaders. “FBH is to be congratulated different fields of action in the sector. The second, for always anticipating the market needs. Although the updated edition of one of the most cited studies it is one of the oldest institutions, it proves that it in the area of health in 2018: “Hospital Scenario in is always innovating with actions like these,” said Brazil 2019”. Valeska Santos, Hospitalar’s president and founder.

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HOSPITAL SCENARIO IN BRAZIL 2019 As a result of the joint effort of the FBH and the National Health Confederation (CNSaúde), the book “Hospital Scenario in Brazil 2019”, by the economist and consultant of both entities, Bruno Sobral, brings an update of the study published last year, which This Manual is produced with assesses the scenario of closure of private hospitals and hospital beds between the years 2010 and the purpose of helping this 2018. The most recent data show that the situation between January 2018 and January 2019 worsened. professional in the face of the If, in the first edition, the study showed that there great and challenging scenario was a reduction of something around 30 thousand beds throughout Brazil, this year’s edition shows that is the management of that in one year the country registered the closure of about 3 thousand beds and 150 hospitals, many health services.” Hospital of them with services provided to the Unified Health System (SUS). Manager’s Manual organizer, “We expected stabilization between last year and Andréa Prestes. this year, but the fact is that, sadly, we have continued to lose many private beds in the last 12 months. We had 31,000 beds lost in 2018, and now we have gone to 34,000 beds lost. Overall, evaluating from 2010 to 2019, we have a loss that reach almost 34,000 private beds, and a total of 560 closed hospitals,” warns the publication‘s author, Bruno Sobral.

According to him, the most impacted by the closure “We expected stabilization of hospitals and beds are the South and Southeast regions. Among the states, the most worrying between last year and this year, situation is that of Rio de Janeiro, which suffered one of the greatest impacts in Brazil. “Some positive but the fact is that, sadly, we impacts were also recorded, such as Brasilia, which was one of the places where the number of beds have continued to lose many increased, hospitals opened more beds, but overall, especially in the Southeast region, in states such as private beds in the last 12 São Paulo and Rio, it was the region where most beds were lost, “adds FBH consultant. months.” Bruno Sobral, author

Although there is no recommendation from Health of the “Hospital Scenario in Ministry on what should be the average number of beds per inhabitant, Brazil has gradually reduced Brazil 2019”. its density. “What exists is a world average, which nowadays revolves around three beds for every 1,000 inhabitants. In Latin America, this ratio drops to two. Brazil went from 2.23 in 2010 to 1.95 now,” explains the book’s author.

| 67 This publication offers an excellent contribution in the preparation of our human resources that act directly in the management area, offering technical knowledge that will serve as a true guide in the daily decision-making”, emphasizes FBH president, Adelvânio Francisco Morato.

HOSPITAL MANAGER’S MANUAL The “Hospital Manager’s Manual” is an organized work According to her, the Manual brings together with the multidisciplinary contribution of authors everything that is necessary in the day to day of a with recognition in different fields of action in the hospital manager, so that it can achieve positive sector. The book presents, in ten chapters, articles that results, much needed nowadays, having a proactive bring light to the development of skills necessary for vision before a world of changes. the manager’s good performance, offering qualified and multidisciplinary knowledge in various fronts of “FBH objective is to work for the evolution of the action in this complex and challenging area that is entire productive chain of the hospital sector. managing hospitals and health facilities. This publication offers an excellent contribution in the preparation of our human resources that act “This Manual is produced with the purpose of directly in the management area, offering technical helping this professional in the face of the great knowledge that will serve as a true guide in the and challenging scenario that is the management daily decision-making “, emphasizes FBH president, of health services. It brings support in some Adelvânio Francisco Morato. chapters addressed in a broad, but no less vertical, with the proposal to structure the whole hospital The digital editions “Hospitals Scenario in Brazil” and management in three main pillars: projects, people “Hospital Manager’s Manual” are now available for and processes, “explains one of the publication download on FBH website (www.fbh.com.br). organizers, Andréa Prestes.

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FBH’S VICE-PRESIDENT LECTURES ON HEALTH COMPENSATION MODELS

ASAP WORKSHOP DISCUSSED HEALTH REENGINEERING IN THE SEARCH FOR PERFORMANCE MODELS

How to improve care quality by reducing costs? This changes in how assistance model works nowadays,” was the question that permeated the third workshop he points out. edition promoted by the Alliance for the Health of the Population during the second day of Hospitalar 2019. Among the obstacles pointed out by Theophanes is Hospitals Association of Minas Gerais State (AHEMG) the fact that hospitals are not involved in promoting president and Brazilian Hospitals Federation (FBH) health, but only in the disease process, “and this is vice-president, Reginaldo Teófanes, was a speaker at their business.” the meeting.

For Teófanes, the answer to that question is in the necessary inversion of care logic, which today is focused on the hospital’s performance, an obsolete “hospital-centered” model. “It is necessary to reverse the focus for prevention and health promotion. The hospital, in fact, should be the end of the line,” he explained.

According to him, discussions about the need for model changes are old and seem to be hindered due to the lack of interest in the implementation. “What is desired is good clinical results for the patient, at an affordable cost, both for the patient and for the health care provider, and decent remuneration to the provider. However, these are goals that require

| 69 IMMUNIZATION

VACCINATION AGAINST HPV IS ESSENTIAL TO PREVENT RECTUM AND CERVICAL CANCER

On the second day of the Annual Meeting of the incidence has increased mainly as a result of HPV American Society of Clinical Oncology (ASCO), held infection (human papillomavirus) and other sexually this year in Chicago, United States, there are studies transmitted diseases. that reinforce the importance of HPV vaccination to prevent rectum and cervical tumors. However, Therefore, two of the main methods for reducing risks despite this recommendation, it is estimated in Brazil are condoms’ use and vaccination against HPV, which that only 48.7% of girls aged 9 to 14 years, the prevents viruses and bacteria spread transmitted by target population recommended by the World Health sexual contact and which are directly related to this Organization (WHO), were immunized. type of cancer development.

“We know that HPV vaccination is included in Cervical cancer, according to data from the National the country’s health agenda but we have seen a Cancer Institute, affects 16,000 women in Brazil a decrease in the demand for the vaccine. This cannot year, making it the third most prevalent cancer type happen at all. If we can get all girls and boys under among women. The disease is silent and, therefore, 13 years vaccinated, the disease reduction will be in about 35% of cases, it ends up leading to death. very effective, “says oncologist Roberto Gil, from the Concern about the increasing rates of the disease Oncoclinical Group in Rio de Janeiro. increases when analyzed the condition’s main cause: the contagion by the so-called human papillomavirus According to him, both anal and cervical cancers are - known as HPV. preventable by HPV vaccination. “In Australia, for example, 90% of people are vaccinated and there The most common sexually transmitted infection the incidence curve of the disease has decreased a type worldwide, the HPV virus massively affects lot”, reinforces Dr. Roberto. For the oncologist, the female population. According to Health Ministry, vaccination should be on a large scale. 75% of sexually active Brazilians will come into contact with HPV throughout their lives, with the Anal cancer occurs in the canal and on the outer virus transmission peak occurring in their 25s. After edges of the anus. This type of tumor accounts for the infection, at least 5% of these Brazilians will 1% to 2% of all colorectal tumors and 2% to 4% develop cervical cancer within two to ten years, a rate of all cancers affecting the large intestine, but its that worries the experts.

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We know that HPV vaccination ONCOCLÍNICAS GROUP is included in the country’s Founded in 2010, it is the largest group specialized in cancer treatment in Latin America. It has worked in oncology, radiotherapy and hematology in 11 health agenda but we have seen Brazilian states. Currently, it has more than 60 units between clinics and hospital partnerships, which a decrease in the demand for offer individualized treatment, based on scientific update, and focusing on patients’ safety and comfort. the vaccine. This cannot happen Its clinical staff consists of more than 500 physicians, at all. If we can get all girls and in addition to multidisciplinary support teams, which are responsible for the comprehensive patients’ care. The Oncoclínicas Group also has an exclusive boys under 13 years vaccinated, partnership in Brazil with Dana-Farber Cancer Institute, one of the most renowned cancer research the disease reduction will be and treatment centers in the world affiliated with Harvard Medical School in Boston, United States. very effective.”

| 71 HOSPITALMED 2019

HOSPITALMED 2019 BRINGS BUSINESS AND INNOVATION IN HEALTH TO THE NORTH AND NORTHEAST

THERE WILL BE MORE THAN 200 EXHIBITORS, WITH 400 BRANDS PRESENT DURING THE THREE DAYS OF EVENT

Joining business to innovation, 7th HospitalMed HOSPITALMED INITIAL EDITION IN 2018 edition brings together health professionals from The fair edition in 2018 brought more than 300 North and Northeast regions at Pernambuco’s brands and 18 thousand visitors to Recife, stimulating Convention Center, in Recife’s Metropolitan Region, networking in stands and in more than 50 content between October 23rd and 25th. events - including congresses, lectures, forums and workshops - spread throughout the pavilion. HospitalMed focus is to provide a meeting between products’ suppliers, equipment, services, technology In 2019, in addition to all events focused on and content for establishments such as hospitals, professional updating and knowledge exchange, laboratories, pharmacies, clinics and offices. This is HospitalMed introduces a differential in the shape linked to the goal of raising the issue of innovation of Iconne fair and 24th Pernambuco Dental Congress importance and technology insertion into the (Copeo), which is already consolidated among medical-hospital environment. professionals in the sector. Both occur within the HospitalMed’s 20 thousand square meters and promise to stimulate business and experiences in the odontological scenario of the region.

The schedule of all events, the content about the exhibitors, organization contact, testimonials of those who have participated, previous editions and other materials and information can be found on the website www.hospitalmed.com.br.

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JOSÉ AUGUSTO ALVES DE PAULA ONE SWALLOW Executive Director of PowerTiss Sistemas. He has more than 20 years experience in Health Sector, held positions in technical and operational areas of Qualicorp Group. In Grupo DOES NOT MAKE Tempo’s Vice-Presidency, he led the GAMA / CRC companies, where he worked in outsourcing the self-management operation and management plan. He holds an MBA in Current and Financial A SUMMER! Sciences and Business Management.

You who have never worked directly in the necessary to identify how much they missed along the relationship between operator and provider have no way. Missing deadlines to appeal for the glosses, services idea of the information complexity level exchanged that expire the billing period... there is everything. between the supplier and the supplementary health paying agent. I, for instance, had no idea! The main point here is the losses. The service provided and not received. For example, the general difficulties Until I became involved for more than a year in this of a midsize operational hospital in being able to relationship, I had the understanding that the National attend more than 60 different operators - each one Supplemental Health Agency (ANS) had pacified the with its own standards. Losses get in the way. Waste? issue of formats and standards with the TISS issue for No, inefficiency. Inefficiency of a chain phase in billing. Well, it standardized, but only the sending. which the legislator did not interfere and the market has adapted to have no standard. Almost everything is Sending the billing (padrão.xml TISS) (TISS standard) done against the clock; no time for checking; mistakes is just the beginning of an insane journey, like those accumulate and payment does not come. reasoning tests that makes you want to give up on the way. Did you know that the payment demo format Hospitals bow down to the payer agent strength. varies from operator to operator? That’s right, there is Operators have customized their systems and no pattern! There is no standard in content or format. have dictated the rules for both the format of Files txt, xls, pdf, html, csv… such diversity will drive the statements and the operational deadlines for the financial department mad. sending, glossing and payment.

What about the content? They only show total or partial Perhaps, no wonder, we are witnessing a huge hospital glosses; demonstrate what is not paid and the provider is networks concentration. Hospital conglomerates the one who does the math to complete what he actually are beginning to gain strength in negotiating and received. Others demonstrate item by item in one file, in softening these rules to avoid inefficiency. It is very another they bring the glosses of previous periods. There common to see an inefficient hospital being acquired are also those who fragment payments from the same lot and, in a few months, reverse indicators such as (the same tax invoice) in different payment seasons. Only billing, occupancy rate, profitability, etc. those who worked in this area can have the dimension of what I’m trying to portray here. Was management missing? Not necessarily. It lacked strength, negotiating power. But why pay any attention to this? After all, hospitals financial areas “handle themselves” to calculate their In this sector, the maxim is still true: “One swallow receivables, but they cannot master all the actions does not make summer!”

| 73 PERMANENT EDUCATION

BAHIA STATE HOSPITALS AND HEALTH ASSOCIATION

STRENGTH IN NATIONAL REPRESENTATION AND IN THE WORK WITH BAHIA’S SUPPLEMENTARY HEALTH

Photo: FBH.

The 2019 year for Bahia State Hospitals and Health the pleadings of the members, minimizing impacts Association (AHSEB) has as its main milestone the through active and proactive follow-up. strengthening of the entity’s representativeness in the national scenario and the work with associated The promoted events also began to integrate a institutions that make up the supplementary health fixed agenda for the association, bimonthly, making network in Bahia. feasible the study, the deepening and discussion of the most current themes and of relevance for the The activities carried out by the association seek sector. “Reference Speakers in the segment’s themes to meet the demands of the associated health are brought to Salvador to point out trends, solutions, institutions through intermediation with health care tools that qualify the services offered and increase providers, government agencies and regulators, the competitive capacity,” explained Mauro Duran councils, forums and partners. The objective is to Adan, adding that the fact that Salvador is hosting seek solutions and alignments necessary to meet the 13th Brazilian Hospitals Convention (13th CBH)

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is a reflection of this work being carried out and a confidence vote in AHSEB’s know how. “At the last seminar we held in April, 96% of the public reported that the event met or exceeded expectations. The discussions are rich and bring information that can be applied directly by health institutions. “

Another line of action that has gained strength is the projects that provides to establishments operating in the sector, such as Acredite - which has the objective of offering to providers facilitating means to register and implement accreditation process, according to ONA and ACSA requirements and under special conditions - among others. It also has a Corporate University that provides technology and knowledge of the most experienced facilitators in the market for institutions to invest directly in their teams and generate satisfaction for their external teams Photo: Edson Ruiz. and clients, training them and updating them on contemporary and recent sector themes.

“International certifiers have been acknowledging, in recent years, the quality services provided by health institutions that integrate the private network in Bahia. Most of them are represented by AHSEB, which has as one of its commitments to contribute permanently in the orientation to establishments with a view to the quality of the health segment of Bahia State,” said the president.

NATIONAL REPRESENTATIVENESS AHSEB is also closer to the discussions of the Health Sector and national demands. That’s because AHSEB’s President, Mauro Duran Adan, integrates the National Health Confederation (CNSaúde) and Brazilian Photo: Edson Ruiz. Hospitals Federation (FBH), reference institutions for the health sector in Brazil.

Adan took office as FBH’s vice president on April 25th and, on March 26th, took office as the general secretary director of CNSaúde. In addition, Bahia’s three other representatives are members of the governing body of the Confederation: Bahia Health Federation (Febase) president, Marcelo Britto, as one of the vice presidents; the president of Union of Hospitals and Establishments of Health Services of Bahia State (Sindhosba), Raimundo Correia, as one of the alternate directors; and AHSEB’s former president, Ricardo Photo: CNSaúde. Pereira Costa, as a Fiscal Council member.

| 75 WELL-BEING

STRATEGY FOR SUCCESS CAN BE IN THE LIFE QUALITY OF EMPLOYEES

RESEARCH COMMISSIONED BY GYMPASS POINTS OUT THAT 67% OF LATIN AMERICAN COMPANIES INVESTS IN LIFE QUALITY PROGRAMS FOR THEIR EMPLOYEES. PHYSICAL ACTIVITY IS THE MAIN ELEMENT OF THESE INITIATIVES, AHEAD OF HEALTHY FOOD CHOICES AND INTERNAL HEALTH CONSULTATIONS

The future of work is influencing the offer of corporate Although wellness practices help in people benefits in Latin America. This is the conclusion of a management strategies, measuring return on study done with 50 companies that, together, employ investment in these programs is still a challenge for about 1 million and a half employees. The survey companies in Latin America: 80% do not calculate found that 67% already have life quality programs return on investment (ROI), and the main reasons for their employees and 57% have increased are cultural difficulties and lack of data. In both projects in the last year or so, that is, corporations are multinational and national companies, only 12% increasingly concerned about incorporating benefits use internal teams to analyze the impact of the that improve their employees’ health. health program on the business, while 8% consult external suppliers. Conducted by Mercer, a health, career and financial security consultant, the global research commissioned THE MILLENNIAL IMPACT by Gympass shows that physical health is among the As corporations seek to upgrade, new generations main wellness initiatives, but that focus may shift to dictate the change of pace. Millennials already mental health over the next two years. A fundamental represent 50% of the workforce in Brazil and pillar for such care, physical activity is one of the proportionately impact the benefits market: 56% options offered by companies, followed by healthy of the companies consulted adjusted their offers food choices and internal health consultations. to meet the interests of this generation, while 32% have specific programs to increase their engagement. “One of the most interesting findings of the study was to attest the relevance of life quality programs to Looking to the future, more than 21% of Gympass’ business. If companies were committed to initiatives global database already offers yoga as a modality like these to reduce health costs before, nowadays the that values mental health. Gympass database has concern is to engage, motivate, attract and retain the found that millennials are the ones that are looking best talents. This is a paradigm shift in the corporate the most for this modality. In numbers, of the 5,906 market and shows a maturation of corporations,” says millennials (23-35 years old) who participated in the Marco Crespo, Gympass Latin America’s CEO. in-house survey, 40.8% reported using Gympass four

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to seven times a week and 41.3% two to three times a week. 54.3% of millennials claim that they began to practice physical activity to have an improvement in life quality. Only 19.2% said it was for losing weight. In addition to life quality, flexibility in work is If companies were committed to on the radar of Y generation professionals. The main characteristics that they value in a job are differentiated schedules (82%), casual dress code initiatives like these to reduce (82%) and home office (51%). health costs before, nowadays For Crespo, the trend to suit to millennials demands is a successful strategy. “We have internal data showing the concern is to engage, that 54.3% of millennials associated with Gympass began to practice physical activity to improve life motivate, attract and retain the quality. Only 19.2% relate the most active life to the goal of losing weight, and this is another proof of how this generation views health care and already best talents. This is a paradigm influences the workforce as a whole. “ shift in the corporate market ABOUT GYMPASS CORPORATE Created in 2012, Gympass is a corporate benefit that and shows a maturation of promotes unlimited access to a global network of more than 44,000 physical activity establishments corporations.” in 15 countries, encouraging employees of partner companies to find an exercise to love. In partnership with Human Resources professionals, Gympass aims to improve people’s health, fighting the sedentary lifestyle around the world.

| 77 HEALTH AND ECONOMY

COMPANY INVOICES R$ 10 MILLION PER YEAR WITH CONFECTION OF HOSPITAL OUTFITS

BrazilH2, a leading company in manufacture and is discussed about suitable dressings in hospital sale of hospital outfits throughout the country, will settings, although some have a “hospitality” area, inaugurate this year, in partnership with the National which ensures that the environment is welcoming Industrial Learning Service (SENAI), a new factory and provides a more humanized experience for with aggregate technology, in the era of 4.0, which patients and their companions. will allow hospitals to sign supply contracts with a longer duration, since it will be possible to make Data from BrazilH2 company estimate that customized products with greater agility, in addition the hospital outfit market in Brazil represents to inventory control, among other advantages. With approximately R$ 50 million investment per month, this factory, the company will be the only one in the or R$ 600 million per year, taking into account that country to manufacture hospital outfits with cutting- the purchase made must be four exchanges of litter edge technology. per bed, comprising bed linen, bath, medical clothes and patient wardrobe. According to Gislaine Toth, CEO A recent survey by the Agência Nacional de Saúde of BrazilH2, “outfit is one of the most important and Suplementar (ANS) (National Supplementary Health visible components for patients in the hospital. As Agency) shows that 48 million people have access people are generally fragile, every detail is important. to private health plans, which generate more than A soft towel, a blanket or sheet with a special touch, a 8 million hospitalizations and about 60 million more elaborate print, everything makes a difference visits to the emergency room, annually. For each of to provide a good user experience,” he explains. these hospitalizations or visits, there is at least one patient, often accompanied by a relative. Each of In addition, it is necessary to think about the financial these visitors is a user who will have an experience and operational cost of these items to the hospital in associated with the provision of hospital services. case of improper purchases and exchanges. Defining an intelligent strategy to purchase hospital outfits But, in general, hospitals are focused on investments impacts the user experience and the institution’s that mainly involve technological segments, systems, profit margin. The outfits must meet the durability equipment, accreditations, physical structure of care, and cost needs, so that it is a solution rather than a big clinical staff, among others. Little or almost nothing problem. As hospital washings are made at more than

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180° C with bleach and aggressive cleaners, it is not any fabric type that meets the quality and durability needs. “Often the hospital requests fabrics that do not have the durability needed for hospital use. Ideally, it is a cotton and polyester combination, so they will be soft to the touch, withstand heavy washing and have The outfit is one of the a longer life span, “adds the executive.

ABOUT BRAZILH2 most important and visible The company was born in 2015, with the objective of offering a complete solution for the structuring of components for the patients corporate outfits for hospitals throughout the country, and is currently the leader in the confection and in the hospital. As people are commercialization in the Brazilian market. BrazilH2 meets the technical and durability specifications of generally fragile, every detail the market and large networks of public and private hospitals, such as Rede D’Or, Hospital do Coração (HCor), São Mateus, Beneficência Portuguesa, Grupo is important. A soft towel, a Santa, Marta Rubim, Mother Day and Green Line. blanket or sheet with a special The products offered are: wardrobe for surgical centers, doctors and patients; sheets and pillowcases; touch, a more elaborate print, blankets; bedspreads; towels; fabrics, among others, all prepared for continuous use and aggressive washes everything makes a difference to to which they are submitted in the laundries. Recently, BrazilH2 has an exclusive partnership with Santista Work Solution, a recognized brand in the hospital provide a good user experience.” market for using more durable fabrics for this segment.

| 79 FBH’S SCHEDULE

FBH PRESIDENT HONORS THE “HEALTH BENCHMARKING 2019” AWARD

The president of Brazilian Hospitals Federation (FBH), Adelvânio Francisco Morato and the president of the Association of Hospitals and Health of Bahia State (AHSEB), Mauro Adan, participated in the 9th edition of the Health Benchmarking 2019 award, on June 6th, at Solar Cunha Guedes, in Salvador, Bahia, considered one of the most important prizes of the medical-hospital segment in Bahia state. This year, 98 managers and entrepreneurs of the sector competed in 24 categories. The Award is performed by the Criarmed Group.

During the event, Morato and Adan took the opportunity to invite the public to participate in the 13th Brazilian Hospitals Convention (13th CBH), which will take place on August 1st and 2nd in the capital of Bahia.

FBH’S PRESIDENT RECEIVES VISIT FROM TAIWAN AMBASSADOR

On May 10th, Brazilian Hospitals Federation (FBH) received a courtesy visit from Ambassador Jian- Gueng Her, Taiwan’s Economic and Cultural Office representative in Brazil. On the occasion, Jian-Gueng congratulated the election of the entity’s new president, Adelvânio Francisco Morato, and made himself available to build future partnerships with FBH.

During the meeting, the Taiwan’s Government representative met the projects and action fronts of FBH, which is a pioneering institution, with more than 50 years acting in defense of the country’s private that Jian-Gueng Her becomes one of the 13th Brazilian health institutions. Hospitals Convention speakers, and present successful cases of Taiwan’s health models for Brazilian managers. Morato took advantage of the ambassador’s visit and The 13th CBH will take place in Salvador (BA), between made the invitation, which was promptly accepted, so August 1st and 2nd.

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FBH PRESIDENT HONORS THE INAUGURATION OF THE NEW HEADQUARTERS OF “CENTRAL DOS HOPSITAIS” (MG)

The president of Brazilian Hospitals Federation (FBH), Adelvânio Francisco Morato, honored, on June 27th, the ceremony to re-inaugurate the headquarters of the “Central dos Hopsitais” (Hospitals Central), where the Association and the Union of Hospitals, Clinics and Health Homes of Minas Gerais (MG) operate. The ceremony was attended by the State Secretary of Health, Carlos Eduardo Amaral Pereira da Silva.

HEALTH TV LAUNCH

The Health TV was launched in June, in Salvador-BA. The event, carried out by the Company Group, was supported by Brazilian Hospitals Federation (FBH) and Amil. The FBH Secretary-General, Dr. Luiz Aramicy Pinto, and the president of the Association of Hospitals and Health of Bahia State (AHSEB), Mauro Adan, attended the event, which also included the lecture “Disruptive innovation in health: trends that are transforming the sector,” by Dr. Claudio Lottenberg.

FBH PARTICIPATES IN MEETING OF THE JOINT PARLIAMENTARY HEALTH FRONT

The Brazilian Hospitals Federation Superintendent, Luiz Fernando Silva, participated in the meeting of the Joint Parliamentary Health Front on June 26th. Presided by the Front President, Ms. Carmem Zanoto (Cidadania- SC), the meeting aimed to approve the new statute and the new work plan of the Parliamentary Front for the upcoming months. The event was also accompanied by the FBH parliamentary adviser, Dulci Tiné.

“We want to congratulate the parliamentarians for this space for dialogue, which will certainly bring very positive results for the sector. We want to say that FBH is also a partner of SUS and that the hospitals that suffered the most in recent years were precisely the small and medium-sized hospitals that are far from the urban centers and provide a relevant service for the Brazilian population,” said Luiz Fernando.

| 81 PATIENT SAFETY

THE INFORMATION SECURITY CHALLENGE IN THE NEW ERA OF BRAZILIAN TELEMEDICINE

The Federal Medical Council (CFM) Resolution But how to guarantee such confidentiality and 2,227/2018, which is about to come into force, allows that the consultation will not be intercepted Brazilian physicians to perform on-line consultations, by cybercriminals? How to prevent sensitive tele-surgeries, telediagnostics, and other forms information leakage? of remote care. In a country with a continental dimension such as Brazil, the gains of this practice According to the Council, patients’ images and data are immeasurable, since those who reside in the must be transported in a network that guarantees more distant regions may be assisted by physicians patient privacy and store such information in remotely. However, this permit will also pose a an environment that ensures its integrity. It is number of information security challenges, requiring also imperative that all those involved in this a broad collaborative effort among physicians, communication, that is, the suppliers that will patients and technology vendors. implement the transmission and storage technologies, are also responsible for the information security. It is a fact that Brazil allows telemedicine practice nowadays, but with some restrictions. Currently, Since we still lack more specific legislation on the physicians can assist other healthcare professionals procedures to which these organizations will have to through teleconferencing, but do not carry on a submit to provide remote assistance, the international remote care. The new CFM resolution allows the standard is expected to be the best example to be remote query in case a previous consultation has provisionally followed. Overall, one of the main already been performed. With this, it is expected references is the Health Insurance Portability and that the consultations will gain more agility and Accountability Act (HIPAA), an American law created reduce queue numbers in hospitals, increasing the primarily to modernize health information flow, number of people assisted in less populated regions, stipulating how personally identifiable information especially in the most needy, difficult to access areas. should be maintained and protected against fraud and theft. However, in times of General Data Protection Regulation (GDPR), it is inevitable that we will question HIPPA determines which entities types are subject to how the security of this information will hold up. It is it, based on health information level and type they known that medical data is extremely valuable on the processes. With this, it outlines guidelines - most of black market, even more than financial information. which are non-technical - that must be followed by This is because the medical data has the capacity to each one of them. Although it is an American law, sensitize the victim, allowing innumerable ways to global manufacturers, developers and technology extort the user through social engineering. servers follow it as a global standard.

CFM has determined that all medical attendance is Mandatory requirements established by HIPAA recorded and stored, and the patient will receive a include: ensuring the confidentiality, integrity, and report in which medical confidentiality is ensured. availability of all records that they create, receive,

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maintain or transmit; proactiveness in identifying and Ensuring patient data significantly increases protecting against cyber threats before they occur; physicians’ responsibility. Therefore, for this and protection against misuse or disclosure of non- initiative to work in Brazil, it is essential that permitted reports. health professionals be supported by partners who provide tools and services that help them to offer In this new era of remote Brazilian medical care, it is a more accurate diagnosis through consulting and imperative that technologies, processes and people training, such as technical resources, support and work in fine tuning, in order to mitigate cyber-attack International experience. risks as much as possible. The damages caused by these cybernetic incidents can be irreparable and undermine a practice that only tends to contribute with the users.

JOÃO ALCÂNTARA Dimension Data specialist.

It is well known that medical data is extremely valuable on the black market, even more than financial information. This is because the medical data has the capacity to sensitize the victim, allowing innumerable ways to extort the user through social engineering.”

| 83 CHAGAS DISEASE

THE CHALLENGES OF OVERCOMING CHAGAS DISEASE, A NEGLECTED PROBLEM

PHYSICIAN REFLECTS ON HOW TO OVERCOME THIS INFECTION, ASSOCIATED WITH DEATH RISK AND MORE THAN US$ 5.6 MILLION LOSS WITH ABSENTEEISM IN BRAZIL

In 1909, the physician Carlos Chagas found, for the first time, the protozoan Trypanosoma cruzi in a DR. EDIMAR ALCIDES BOCCHI human being’s blood. It was a 3-year-old girl named Freelance professor in Cardiology, associate Berenice, who was in the midst of acute illness. After professor at Faculty of Medicine of São Paulo University (USP), associate editor of Journal of 110 years, Chagas disease is still far from eradicated. the American College of Cardiology (JACC) and Endemic in 21 Latin American countries, it affects head of Heart Failure Unit of Heart Institute of approximately 6 million people worldwide. Hospital das Clínicas of Faculty of Medicine of São Paulo University (InCor-HCFMUSP). Also known as American trypanosomiasis, we are talking about a neglected and potentially fatal condition. According to estimates, it causes 12,000 about 30% of those infected will have heart or deaths per year. And the problem has been growing digestive disease. Chagas cardiomyopathy is the most in recent years in Brazil, a country with at least 1 critical manifestation, responsible for the increase million infected. The Health Ministry (MS) states that in deaths due to cardiac arrhythmias or progressive the number of acutely ill disease cases more than heart failure, in addition to causing stroke. tripled from 2008 to 2017. To combat infection, it is necessary to look at the According to World Health Organization’s First Report patient’s condition and act on different fronts. on Neglected Tropical Diseases, it is estimated that One of them is the insect control, known as barber, 752,000 work days per year are lost due to the deaths its transmission vector, mainly in residences. This resulting from the disease in Latin America. It is a US$ requires public action to promote campaigns for 1.2 billion waste in lost productivity. In Brazil alone, the detection and application of insecticides in absenteeism of workers affected by Chagas disease endemic areas, as in the North of the country. As a represents an estimated minimum loss of US$ 5.6 form of individual prevention, repellents and long- million per year. sleeved clothing are recommended during nocturnal activities in forest areas. In the initial acute phase, patients may experience symptoms such as face and leg swelling, headache, However, the protozoan T. cruzi can be disseminated weakness and continuous fever. In the chronic phase, in other ways: blood transfusion, contaminated food,

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and organ transplantation are among them, making Although Brazilian research centers were pioneers eradication more complex. Incidentally, I emphasize in chagasic patients treatment with chronic heart here oral transmission possibility, through the ingestion failure through transplantation, the procedure of contaminated foods, such as açaí and cane juice. numbers are still low in relation to impacted population. In addition, the health workers training In addition to efficient public policies, the scientific must be encouraged. According to a recent community needs to invest efforts to improve Chagas study developed by Oswaldo Cruz Foundation in disease understanding, encouraging more research partnership with the organization Médecins Sans production. We need data to analyze the disease and Frontières (MSF), only 32% of the professionals its social impact, as well as new treatment forms. Some interviewed in Basic Health Units (BHU) know the progress in this direction is already being made. This disease’s diagnostic procedures and only 14% is the case of the first study that will have Brazil and know the medicine type indicated. Latin America countries as the stage to investigate a treatment for heart failure in patients with Chagas We are facing a global public health problem. As the disease. It should be started as early as 2019. population is connected and traveling to different corners of the world, Chagas disease started to The medication Sacubitril-Valsartan, which has been reach more and more places not impacted by shown to be effective in patients with heart failure the barber. Examples: United States, Canada and with reduced ejection fraction, will be tested for European countries. the treatment of this disease specifically caused by Chagas disease. On the other hand, we need to It is necessary to increase investments and remain firm with existing programs, such as heart coordinate efforts, strengthen public and third transplantation. In 2018, the country performed sector programs and count on private initiatives for about 380 procedures of the type - increasing research development and health services if we want numbers each year. to overcome Chagas disease.

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Photos: Sandro Damasceno.

REDE D’OR SÃO LUIZ OPENS EXCELLENCE HOSPITAL IN DF

DFSTAR WILL HAVE STATE-OF-THE-ART MEDICAL EQUIPMENT AND TECHNOLOGIES TO PERFORM HIGH COMPLEXITY MEDICAL CARE

Rede D’Or São Luiz inaugurated, on June 11th, the “Everything was designed to welcome the patient DFStar Hospital, its fourth unit in Brasilia. “The new from arrival and offer him the best possible facility has state-of-the-art infrastructure and medical combination of high technology and humanized staff for the best clinical results,” says Dr. Paulo Hoff, medicine. Based on our experience in the Star line, who will coordinate the Oncology area and is one of in the construction and operation of our hospital the largest international references on the subject. network and in international referrals, we structure With a R$ 450 million investment, in a 30 thousand flows and processes that emphasize extreme care to square meters area, in “Asa Sul” Hospitals Sector, the obtain the best clinical results,” says D’Or São Luiz new unit will generate about one thousand direct jobs. board chairman, Dr. Jorge Moll.

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To ensure patient exclusivity, DFStar will have 112 With the tablet it is possible to have access to the hospitalization beds and 30 ICU (Intensive Care “Patient Agenda”, a space that informs the whole Units). The hospital will offer personalized attention medicines and test routines that must be performed. and has architecture, gastronomy and state-of-the-art The Agenda is filled by the hospital’s care team and services designed to assist in the best and quickest presents meal times, procedures, physiotherapy and recovery of its patients. hygiene. In the application, the patient also has access to all exams concerning him/her in the unit. For each A DIFFERENTIATED CONCEPT patient, a Care Plan is developed, which also seeks to The new unit presents as a conceptual basis the involve the accompanying family member. This Plan prioritization of personalized service in all sectors. stays on the tablet and seeks to inform and integrate The Star brand hospitals stand out for being a one into the recovery process, including tasks that reference in highly complex care, offering the most must be performed during the hospitalization, such advanced in terms of medical equipment and support as daily walks. staff selection and clinical formation. The façade of new hospital is inspired by the Brazilian Each suite will be equipped with a tablet, with “Cerrado” and decoration will be filled with works exclusive application that allows communication by of great local and national artists. Like Brasilia, the videoconference with the nursing team, control of DFStar unites modernity with the cozy experience of hotel items and contact with the ombudsman at any a personalized service. time during the entire hospitalization period. The solution is called Smart Hospitality.

Photos: Sandro Damasceno.

| 87 UNHEARD TECHNOLOGY IN THE have the Tumor Board, a periodic meeting with direct COUNTRY access to the major international research centers. Now, DFStar will bring new features to the capital, such as with DFStar, this entire structure also becomes a direct Gamma Knife Icon’s newest model, equipment which channel for doctors in the Federal District,” explains Hoff. will be unique throughout Latin America and can target a high concentration of radiation in restricted ABOUT REDE D’OR SÃO LUIZ areas, a highly relevant technology in brain tumors Founded in 1977, Rede D’Or São Luiz is the largest treatment for example. With this technology, there is private hospitals network in Brazil, with presence in less risk of injuring healthy areas during treatment. Rio de Janeiro, São Paulo, Federal District, Pernambuco, Maranhão, Sergipe and Bahia. The Group operates with The Gamma Knife is an alternative to traditional brain 44 hospitals, 43 of which are owned and a hospital surgery, being a non-invasive stereotactic neurosurgery under management. The Network has 6.4 thousand apparatus, without scalpel or incision use. Instead, it operational beds and 7 thousand total beds, and plans uses up to 201 beams of high-precision rays to control to reach 8,1 thousand beds in five years. In total, there both malignant and benign tumors as well as vascular are 44,100 employees and 87,000 accredited doctors, and functional disorders in the brain without injuring who perform about 3.69 million emergency care, 220.5 surrounding healthy tissues. The hospital will also thousand surgeries, 32.3 thousand births and 477 have two Elekta Versa units, considered to be state-of- thousand admissions per year, as well as 4 thousand the-art equipment in radiotherapy. robotic surgeries in three years since the beginning of this new service. Rede D’Or São Luiz also has the “The great advantage of a network is that we can share Oncology D’Or and OncoStar, a network of clinics best practices. In São Paulo’s OncoStar Clinic unit, we specialized in cancer treatment in seven Brazilian states.

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PARANÁ HOSPITALS ASSOCIATION WILL HAVE A WOMAN IN ITS PRESIDENCY FOR THE FIRST TIME

MÁRCIA RANGEL DE ABREU TOOK OVER PARANÁ HOSPITAL IN JULY TO SERVE A THREE- YEAR TERM. SHE ASSUMES DOCTOR BENNO KREISEL´S PLACE, WHO HAS BEEN AT FBH´S VICE-PRESIDENCY AND IS NOW A FISCAL COUNSELOR.

The health executive Márcia Rangel de Abreu has just Márcia Rangel is pedagogue, post-graduate in Health been elected to preside, for the next three years, the Services Administration from Pontifical Catholic Paraná State Hospitals Association (AHOPAR). She was University of Paraná (PUC-PR), having worked for already in the vice presidency and now replaces Benno more than 25 years in clinics and hospitals direction. Kreisel, who has been in charge of the hospital since She has experience in quality systems and effective July 2010 and has had two successive re-elections. trajectory in AHOPAR’s executive officers, as well Márcia Rangel is the first woman to ascend to the as in the Syndicate and in the Federation of State largest function at the Association, which, in last March, Hospitals and Health Services Establishments of completed 46 years of existence and is linked to Paraná (FEHOSPAR), trade union organizations whose Brazilian Hospitals Federation (FBH). AHOPAR, according roots date back to the early 1960s and which never to its social status, congregates hospitals, health homes had a woman occupy the highest directive function. and other similar establishments operating in Paraná. Born in Ponta Grossa (PR), Márcia Rangel also “To assume AHOPAR´s presidency is, above all, integrates the board of directors of the National to make a commitment to strengthen the entity’s Health Confederation (CNSaúde), and has proposals, representing the business community and participated actively in technical work groups at the public and private sectors of our economic and National Supplementary Health Agency (ANS). She social segment, above all. Our commitment will be is also a current member of the board of directors based on the changes that have been taking place of FEHOSPAR, an associate member in Full Fellow in the market´s behavior, the needs of those who category in Brazilian College of Health Executives consume our services, as well as the monitoring of (CBEXs / Chapter Paraná) and FEHOSPAR´s executive country’s politics and economy, which invariably director, besides acting as executive director at have a direct impact on small, medium and large Paraná´s Human Reproduction Center. businesses” , said the new president. Although the mandate starts on July 24th, the festive She also spoke about her management plan, which ceremony of AHOPAR´s new directors board for the “will be focused on mutual collaboration, through the 2019-2022 triennium will take place at a dinner associative model, seeking Paraná´s economic and party during the 9th Paraná Health Meeting, to be social development.” “We also intend to promote a held on 24th, 25th and September 26th, 2019, at new status of associate growth towards ensuring a Expo Unimed Curitiba (Positive University). safe, quality health of value, with results for all links in the productive and consumer chain,” he adds.

| 89 AHOPAR

When it was created, AHOPAR had only two women among its 16 founders, who directed the main hospitals at the time in Curitiba: Sister Veronica Tartas, Hospital Nossa Senhora das Graças, Sister Eunice Benato, and Maternidade Nossa Senhora de Fátima. The first president was Dr. Moyses G. Paciornik, succeeded by Drs. Ernani Simas Alves, Carlos Franco Ferreira da Costa, José Francisco Schiavon, Luiz Pedro Pizatto, Reinaldo Camargo Scheibe, José Geraldo Lopes de Noronha, Ariovaldo de Mello Arantes, Salim Haddad, Renato Merolli and, in the last nine years, by Benno Kreisel.

In these 46 years, the predominantly male space gradually gained female participation. Today, some of the major hospital organizations in capital and also the state have women in managerial roles. The newly elected board of directors of AHOPAR are composed of eight women. In addition to the president, the deputy Neidamar Pedrini Arias Fugaça is Hospital Vita Batel´s superintendent; Secretary- General Marina Abe is the administrator of Sugisawa Hospital; the 1st treasurer Karin Ratzke Tavares is from the Heidelberg Clinic; the 2nd treasurer Regina Ramina Montibeller is from the Neurological Institute of Curitiba; the director of sociocultural relations Catarina Harue Yagueshita is from Policlínica Capão Raso; and the effective counselors Melissa Bizinelli Gubert Bertão and Ana Carolina Hildebrand Seyboth answer, respectively, for Maternidade Curitiba and Hospital Filadélfia (Marechal Cândido Rondon).

The Association represents 342 private hospitals, with 20,497 beds, of which 64.6% are destined to public health care, and the remaining 35.4% to the supplementary network and private care.

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SOCIAL SECURITY AND FAMILY COMMITTEE CREATES WORKING GROUP TO STUDY THE SUS TABLE

A Working Group (WG) of the Social Security and The request for the accomplishment of the event was Family Committee (CSSF) of the Chamber of Deputies made by the WG coordinator, Deputy Luiz Antônio was created to study a revision of the Unified Health Teixeira Jr. (PP-RJ). According to him, the outdating of System Table (SUS) and to discuss its updating the Table has been causing serious and irreparable and modernization with respect to values and problems to the whole system, because, due to the procedures. The WG intends to compose its report precarious values paid to services and procedures, it with suggestions for the revision of the Table of SUS is increasingly difficult to find qualified institutions, Procedures presented by several entities of the sector, professionals and technicians who agree to provide among them the Brazilian Hospitals Federation (FBH), these services to system users. which has participated in one of the hearings.

TAX REFORM PROJECT THAT IS BEING CONDUCTED IN THE CHAMBER OF DEPUTIES

The project, authored by Baleia Rossi Deputy (MDB- serve as a test to verify the collection potential of the SP), has as its main point the unification of five taxes: new tribute. Gradually, the tax would be calibrated to three federal (IPI, PIS and Cofins), one state (ICMS) and replace the revenues of the other taxes that are being one municipal (ISS). They would give way to the Tax extinguished. At the end of the process, the IBS should on Goods and Services (IBS). The proposal foresees a have a 25% rate. This is a Constructional Amendment transition of ten years, where, in the first year, the IBS Proposal(PEC) that will need to be approved by a would be in force at a rate of only 1%, initially replacing Special Commission in the Chamber of Deputies, and a reduction in the Cofins’ collection. This period would its text may still be amended.

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PROJECT THAT DISSEMINATES LIST OF WAIT FOR SURGERY IN SUS

The proposal (PLS 393/2015), which obliges Currently, at the Chamber, the text was approved in the governments to publish on the internet the lists of Work, Administration and Public Service Commission patients from elective surgeries in hospitals that are (CTASP) with changes that restrict access to the list associated with the Brazilian Unified Health System only for SUS managers and for waiting patients. (SUS), was approved by the Federal Senate and sent The substitute text still requires disclosure of the to the Chamber of Deputies. The text says that lists consultations list and complementary examinations should be posted on the internet with the identity and extends the frequency of updating the lists of number, the order in which it is queued and the date surgery from weekly to biweekly. The proposal must of the surgery schedule. Patients’ names will be be analyzed by more committees in the Chamber and preserved by privacy respect. The lists should also then goes to Plenary vote. be divided by medical specialty and updated weekly.

LETTER OF SUPPORT FOR APPROVAL TO MP 869/2018 - GENERAL DATA PROTECTION REGULATION (GDPR)

The Brazilian Hospitals Federation (FBH), along with allow the shared use of data controllers for economic other entities of the sector, signed a support letter purposes only if the data exchange is necessary for for the approval of the Provisional Measure (MP) the provision of health services and pharmaceutical 869/2018, which amends the General Data Protection or health care, included diagnosis and therapy, to Regulation (GDPR). During the MP 869/2018 process, benefit the interests of the data subject. health entities made suggestions to the text of the rapporteur, Orlando Silva (PCdoB-SP), to enable the Such sharing without the holder’s prior consent in the health systems and services management, as well as health area shall allow the execution of financial and the provision of quality and safety services in patients’ administrative transactions resulting from the use and benefit, always adopting appropriate and specific provision of these services. The idea is to allow the measures that respect their rights and freedoms. The sharing of sensitive data between various providers content was approved in the Federal Senate on May and health care professionals and health authority for 29th and sent to the presidential sanction. the benefit of the holder. Other suggestions made by the rapporteur during public hearings were requests The sensitive personal data use for economic gain is to prohibit private health plan operators from generally prohibited; however, rapporteur Orlando processing sensitive data for risk selection in any type Silva has accepted the industry entities suggestion to of contract or for the exclusion of beneficiaries.

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SUPREME FEDERAL COURT (STF) DECIDES THAT PREGNANT AND BREASTFEEDING WOMEN CANNOT EXERCISE INSALUBRIOUS ACTIVITIES

The Plenary of the Supreme Federal Court (STF) After STF’s decision, the removal of the pregnant or upheld the Direct Action of Unconstitutionality breastfeeding woman is now mandatory regardless (ADI) 5938, filed by the National Metalworkers of the unhealthiness degree of the workplace. Confederation, to declare unconstitutional the sections of the Consolidation of Labor Laws (CLT) The questioned norm has admitted that pregnant introduced by the Labor Reform Act 13,467/2017) women could practice activities considered that admitted the possibility of pregnant and insalubrious in medium or minimum degree and that breastfeeding workers to perform insalubrious the breastfeeding women could perform insalubrious activities in some cases. The majority understood that activities to any degree, except when they presented the expression “when presenting a health certificate, a health certificate that recommended the removal. issued by the woman’s trustworthy doctor” opposes ADI 5958 was upheld. the constitutional protection of the mother and child.

PRESIDENT SANCTIONS, WITH VETOES, LAW THAT AUTHORIZES THE INVOLUNTARY INTERVENTION OF DRUG DEPENDENTS

Jair Bolsonaro President has sanctioned, with vetoes, The sanctioned text also provides possibilities for re- the Law that authorizes the involuntary hospitaliza- ceiving users or drug addicts in these communities tion (without consent) of chemical dependents, and “for membership and voluntary stay”. its text was published in the Union’s Official Gazette. However, it was denied permission for non-medical Law 13,840 / 2019 amends several points of the Na- people to assess the dependent’s death risk; the tional System of Public Policies on Drugs (Sisnad), prediction that the National Drug Policy Secretariat which coordinates measures related to psychoactive would define the rules of therapeutic communities drugs use prevention, attention to users’ health and and that these communities would be characterized trafficking repression. as “health facilities”; and the physical isolation of the user in those places. The text defines the care conditions for drug addicts and deals with the financing of drug policies. Accor- The vetoes will still be analyzed by the National Con- ding to the Law, involuntary hospitalization can only gress to be maintained or overthrown. be done in health units and general hospitals and will depend on the endorsement of a responsible doctor, with a maximum term of 90 days.

DULCI TINÉ Brazilian Hospitals Federation’s (FBH) Parliamentary Advisor.

| 93 EVENTS CALENDAR

HEALTH SECTOR EVENTS’ CALENDAR – 2019

AUGUST AUGUST

13th BRAZILIAN HOSPITALS CONVENTION 29th HOLY HOUSES HOSPITALS AND Date: 1st and 2nd PHILANTHROPIC HOSPITALS’ NATIONAL CONGRESS th th Location: Gran Hotel Stella Maris – Salvador/BA Date: 13 to 15 Organization: Brazilian Federation of Hospitals (FBH) Location: Brazil 21 – Brasília/DF Website: https://www.convencaofbh.com.br/ Organization: Confederation of the Holy Houses of Mercy, Hospitals and Philanthropic Entities Website: http://cmb.org.br/congresso/

AUGUST SEPTEMBER

4th INTERNATIONAL FORUM ON HEALTH LEADERSHIP INTERNATIONAL TRADE FAIR FOR REFRIGERATION, Date: 30th AIR-CONDITIONING, VENTILATION, HEATING, AIR AND WATER TREATMENT Location: Tomie Ohtake Institute – São Paulo/SP Date: 10th to 13th Organization: Brazilian Association of Diagnostic Medicine (ABRAMED) Location: São Paulo Expo – São Paulo/SP Website: http://www.abramed.org.br/filis/ Organization: Reed Exhibitions Alcantara Machado Website: https://www.febrava.com.br/

SEPTEMBER SEPTEMBER

MEDICAL FAIR THAILAND HEALTHCARE INNOVATION SHOW th th Date: 11th to 13th Date: 18 to 19 Location: Bangkok International Trade and Location: São Paulo Expo – São Paulo/SP Exhibition Center – Bangkok, Thailand Organization: UBM/Live Healthcare Website: https://www.medicalfair-thailand.com/ Site: https://saudebusiness.com/his/

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SEPTEMBER SEPTEMBER

BUSINESS HEALTHCARE FORUM ANALYTICS LATIN AMERICA Date: 20th to 22th Date: 24th to 26th Location: Casa Grande Resort & Spa – Enseada, Location: São Paulo Expo – São Paulo/SP Guarujá/SP Organization: Nürnberg Messe Achievement: Healthcare Website: https://www.analiticanet.com.br/pt Website: https://eventosgm.grupomidia.com/forum- healthcare-business/

OCTOBER NOVEMBER

HOSPITALMED IHF MUSCAT - 43RD WORLD HOSPITAL CONGRESS Date: 23rd to 25th Date: 7th to 9th Organization: Pernambuco Convention Center – Location: Muscat, Oman Recife/PE Director: International Hospital Federation (IHF) Website: https://hospitalmed.com.br/feira2019/ Website: https://worldhospitalcongress.org/

NOVEMBER NOVEMBER

SYNAPSIS FBH JOURNALISM AWARD MEDICAL FAIR th Date: 12 Date: 18th to 21st Location: Brasília/DF Organization: Messe Düsseldorf – Germany Organization: Brazilian Federation of Hospitals (FBH) Website: https://www.medica-tradefair.com/ Website: http://fbh.com.br/premio-synapsis/

NOVEMBER DECEMBER

PRIVATE HOSPITALS’ NATIONAL CONGRESS CELEBRATE 2019 Date: 26th to 28th Date: 11th Organization: Transamerica Expo Center – São Paulo/SP Location: Hotel Unique São Paulo – São Paulo/SP Website: https://www.conahp.org.br/ Organization: Grupo Criarmed Website: https://www.celebra2018.com.br/

| 95 ECONOMIC INDEX WORKSHEET

INFLATION INDEX (%) PERIOD IN THE MONTH 12 MONTHS IPCA MAY/2019 0,13 4,66 INPC MAY/2019 0,15 4,78 IPC Fipe JUNE/2019 0,15 3,88 IGP-M JUNE/2019 0,80 6,51 IGP-DI JUNE/2019 0,63 6,04 ICV-DIEESE JUNE/2019 0,21 2,96 Sources: IBGE, Fipe, FGV e Dieese. Elaboration: Valor Data.

APPLICATIONS INDEX IN % Selic over, per year 6,40 CDI over Cetip, per year 6,40 Future DI, per year (Jan./2021) 5,81 TR (04/09) 0,0000 Old Savings (04/09) 0,5000 New Savings (04/09) 0,3715 Sources: Central Bank and B3. Elaboration: Value Date.

FIPE HEALTH MONTH YEAR % April 2019 1,27 May 2019 0,25 June 2019 0,18

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As melhores cabeças dedicadas a aumentar a qualidade dos serviços de saúde do país serão reconhecidas nacionalmente.

Participe!

fbh.com.br/premio-synapsis [email protected]

Inscriçes Aertas!

| 97 98 | REVISTA VISÃO HOSPITALAR

| 99 100 | COMO A INTELIGÊNCIA EM SAÚDEREVISTA VISÃO HOSPITALAR COMPARTILHADA DESPERTA SOLUÇÕES BRILHANTES?

NÓS SABEMOS COMO. NÓS SOMOS O COMO.

| 101 Palestrantes internacionais confirmados:

Derek Feeley Donald M. Berwick Pedro Delgado Presidente e CEO do IHI Presidente Emérito e Senior Fellow do IHI Mestre em Ciência, Diretor do IHI Europa e América Latina PROGRAMAÇÃO:

15 e 16 de outubro: 5º Fórum Latino-Americano de Qualidade e Segurança em Saúde. 13 A 16 DE OUTUBRO DE 2019 Fique por dentro de todas as informações do evento e garanta a sua vaga pelo site: INSC102R |I ÇÕES ABERTAS www.einstein.br/eventos/ihi REVISTA VISÃO HOSPITALAR

Palestrantes internacionais confirmados:

Derek Feeley Donald M. Berwick Pedro Delgado Presidente e CEO do IHI Presidente Emérito e Senior Fellow do IHI Mestre em Ciência, Diretor do IHI Europa e América Latina PROGRAMAÇÃO:

AF-ANUNCIO-NOVO_CODIGO-205x275.indd 1 4/29/19 11:00