Integrated Report 2020 INTEGRATED REPORT 2020

Paulista Unit Rua Treze de Maio, 1.815 Bela Vista CEP 01327-001 HOSPITAL ALEMÃO OSWALDO CRUZ São Paulo-SP Tel.: 11 3549 1000

Campo Belo Unit Avenida Vereador José Diniz, 3.457 Sobreloja Campo Belo CEP 04603-003 São Paulo-SP Tel.: 11 2344 2700

Vergueiro Unit Rua São Joaquim, 36 Liberdade CEP 01508-000 São Paulo-SP Tel.: 11 3549 1000

www.hospitaloswaldocruz.org.br

/hospitalalemaooswaldocruz /company/hospitalalemaooswaldocruz /hospitalalemaooswaldocruz /hospitalalemao Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 4 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | ABOUT THIS REPORT 5

Contents About this report

WELCOME TO THE 2020 EDITION OF THE INTEGRATED REPORT ABOUT THIS REPORT 5 OF HOSPITAL ALEMÃO OSWALDO CRUZ 2020 in indicators 6 GRI 102-45, 102-46, 102-48, 102-49, 102-53 Message from the Chairman of the Board of Trustees 8 Message from the Chief Executive Officer 10 The purpose of the document is The economic-financial, environ- 1. OUR HOSPITAL 12 to render accounts to employ- mental, social and governance Timeline 16 ees, clinical staff, associates, (ESG) indicators cover the peri- Our Units 18 suppliers, partners, patients od from January 1 to December Business model 22 and the community about the 31, 2020 and encompasses all Corporate governance 24 Institution's results, investments units directly maintained by the Ethics, integrity and risks 28 and projects in an extremely Hospital - Paulista, Vergueiro, challenging year for health both Campo Belo and, in some cases, 2. STRATEGY 30 in Brazil and in the world, due informed throughout the text, Planning, goals and indicators 36 to the Covid-19 pandemic. the Complexo Hospitalar dos Es- Capital allocation 42 tivadores e o Ambulatório Médi- Sustainability agenda 47 Hospital Alemão Oswaldo Cruz co de Especialidades Dr. Nelson 3. COPING WITH COVID-19 50 holds transparency as an im- Teixeira, both managed by Protocols and care directives 53 portant premise, adding value to Instituto Social Hospital Alemão Multimedia communication 57 the brand and allowing to form Oswaldo Cruz. (Social Institute). Taking care of our team 59 bonds of trust with its stake- The main novelty for the scope holders. The report is guided by of the report is AMBESP - Am- 4. HIGH PERFORMANCE 64 the Global Reporting Initiative bulatório Médico de Especiali- Quality, safety and clinical outcomes 66 (GRI) Standards, the integrated dades Dr. Nelson Teixeira in the Business result 70 reporting methodology of the GRI indicators focused on the International Integrated Report- impact on society. 5. CARING FOR RELATIONSHIPS 74 ing Council (IIRC), guidelines Patient's journey 78 of the Brazilian Association of Themes such as the manage- Our team 81 Medical development 89 Listed Companies (Abrasca) and ment and adaptation of the Supply chain 91 the Institution's own strategic business model to the context of In addition to this complete version, planning. The selection of the the pandemic, the advances in 6. INNOVATION, RESEARCH AND EDUCATION 94 available in print and PDF file, the data presented is associated Innovation, Research and Educa- Innovation projects 97 Institution publishes the Integrated Report to the materiality, listing the tion and the performance of the Education and knowledge generation 102 in a summarized format on the website most relevant topics for man- Hospital based on its strategic The future of health and new businesses 107 https://www.hospitaloswaldocruz.org. agement and communication planning are added to issues br/o-hospital/relatorio-integrado (onepage according to the perspective such as human development, en- 7. SOCIAL RESPONSIBILITY 108 report), with a selection of the main of the stakeholders. vironmental management, care Impact on Brazilian health 110 indicators and highlights of the year. practices and protocols and the Instituto Social Hospital Alemão Oswaldo Cruz 113 social impact promoted through the administration of public 8. ENVIRONMENT AND ECO-EFFICIENCY 116 health equipment. If you have GRI CONTENT INDEX 121 any questions about the content Certifications and awards 129 of this report, please contact us Credits 130 at [email protected]. 6 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | ABOUT THIS REPORT 7

2020 in indicators GRI 102-7 INSTITUTION PERFORMANCE HIGHLIGHTS COLLABORATION IN THE DE- material sustainability issues CARE QUALITY AND VELOPMENT OF HEALTH SYS- SECURITY TEMS AND INITIATIVES FOR AC- CESS TO MEDICAL TREATMENT RELATIONSHIP INNOVATION, RESEARCH · 97.7% adherence to WITH OPERATORS AND EDUCATION the venous thromboembolism · 68,893 visits in 2020 at AMBESP (VTE) protocol - Ambulatório Médico de Especialidades Dr. Nelson Teixeira (medical consultations, · R$ 258.5 · 164 study publications multidisciplinary consultations and surger- million in revenue from the in journals · 83.3% adherence ies/biopsies) Paulista Unit originating to antibiotic administration from global daily rates in 1 hour within the sepsis · 53 researchers involved protocol · 590 visits in the beds of the Cam- in the Covid-19 Coalition, paign Hospital of Complexo Hospitalar · 4% improvement in the 14 from Hospital Alemão dos Estivadores (Hospital Vitória). (hos- Institution's receipt deadlines Oswaldo Cruz · 0.7% crude hospital pitalizations in medical clinic and ICU) infection rate · 64 studies conducted · R$ 192.7 million in tax im- CLINICAL STAFF by the International Re- · 0.8% surgical site munity in the 23 Proadi-SUS projects ENGAGEMENT search Center, 23 of which infection rate (2018-2020) focused on therapeutic alternatives for the treatment · customer satisfaction: · 100% of doctors of Covid-19 EFFICIENT ECONOMIC PER- from the registered clinical 76.7% NPS FORMANCE IN THE USE OF staff evaluated in the per- RESOURCES formance program · 506 enrollments in technical, undergraduate and postgraduate courses EMPLOYEE HEALTH · R$ 852.497 million of net + 6,795 students in fully revenue, 1.2% more than 2019 ENVIRONMENTAL distance learning courses, SUSTAINABILITY with 1,570 studying free of charge · 2,197 medical visits in · 59.6% increase in net the Integral Health Program revenue at the Vergueiro Unit · 288.48 tons of waste destined for recycling · 35 students graduating from courses in the empha- · 86% of employees · 85.6% increase in net revenue sis areas taking the periodic medical in the area of Innovation, Research and exam Education · 38.4 total hours of training per active employee · R$ 31.5 million invested in expansion and infrastructure

· 5.6% Ebitda margin 8 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | ABOUT THIS REPORT 9

Message from the Chairman of the Board of Trustees GRI 102-14 In addition to the great dedi- vative ways, as well as in the our associates, our executive cation of everyone in matters breadth of research and educa- officer and his team and my 123 YEARS LATER, A MISSION THAT GOES ON related to the pandemic, the tion activities, so important for colleagues on the Board for the Board worked hard to improve our development. incredible dedication and coop- In these 123 years of activity, It was a time similar to what we Hospital Alemão Oswaldo Cruz the governance of the Hospital. eration facing the difficulties. we have experienced several are experiencing today, both from the first day of the pan- 2020 was a year of great chal- moments in history that have in terms of symptoms, as well demic, has gone through great Always with the coordination lenges both for the results of I count on the support of all to had a global impact. In 1918, the as high rate of contamination ordeals to maintain our Mission, of one of the members of the the Hospital and in the financial continue positively impacting world was shaken by an influ- and mortality. The Spanish “To be precise and human to Board of Trustees and the sphere, when our capacity for re- the development of health in the enza pandemic, which became flu, which arrived with 200 guarantee the best experience participation of associates, five action and resilience was tested. country, through patient care known as the Spanish flu and crew members from a Brit- and health results for the patient”, committees were put together and medicine of excellence and infected almost a quarter of the ish ship coming from Lisbon and our Values “Patient Safety; with the purpose of helping the Despite a strong improvement high complexity, making Hospital world's population. At the time, that docked in Rio de Janeiro, Warmth; Truth; Collaborative Pro- executive management on differ- in results in the last months of Alemão Oswaldo Cruz a reference Associação Hospital Alemão was victimized mainly the elderly tagonism; Innovative Tradition ”. ent issues and supporting the the year, in 2021, we will face in Latin America. In order to pre- already established in São Paulo, and had social distancing as decision-making process of the new challenges arising from the serve the legacy of our Institution, a city in full development, but the main measure against the This was only possible through Board of Trustees. The commit- pandemic. we will remain firm, exercising our severely plagued by the disease. spread of contagion. Today, the tireless dedication, committees are: Management and Risk; vision: “full health care takes place Pervaded with a spirit of soli- Covid-19 travels by plane in a ment and effort of our health Strategy; People; Innovation My gratitude to our clinical staff, in harmony with knowledge and darity, aided by donations from much faster and widespread professionals, who placed their and Technology; Research and direct and indirect employees, compassionate care”. the German community in the way, but it faces an advanced work above the risks of contam- Education. country, the Association built an medicine in the treatment and ination and, many times, even emergency hospital in two days a fast formulation of vaccines gave up family life. With the support and coordi- in the former Ballroom of the with a much more efficient nation of the Strategy Commit- Germania Society. A year later, communication - which allows On behalf of the Board of tee, we reviewed our strategic and with the end of the First rapid exchange of information. Trustees, I would like to express planning for the next 5 years. World War, the Association was our immense gratitude to all Vigorous growth, technologies able to meet again and resume Despite the differences, the these professionals who make to support the development of the works of what is now the health system was and is still the Hospital Alemão Oswaldo efficiency and quality of patient Hospital Alemão Oswaldo Cruz. extremely challenged. Hospitals Cruz an institution of reference care, as well as becoming a had to react quickly, imple- and excellence. center of excellence in our areas menting crisis committees and of emphasis - oncology and di- putting together tactical and To all other employees, without gestive tract - were some of the strategic plans to be able to distinction, from the desk recep- topics set. take care of patients in the best tion to the board of directors, we way. As I heard from a colleague, also thank you for the motivation, The People Committee con- those in pain are in a hurry, those sense of responsibility and profes- tinued to work to attract new in pain are in an urgency. sionalism in maintaining and im- members to further contribute proving the quality of our services. to our group (in 2020 there were 21 new members).

The other committees work We remain confident in the strength of to improve our audit and risk our institution to face the challenges control system, in the search for technological transformation Weber Porto and preserve our legacy and incentives for more inno- President of the Board of Trustees 10 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | ABOUT THIS REPORT 11

Message from the CEO

ACTION IN DEFENSE OF LIFE AND SCIENCE GRI 102-14

When we started our journey order to ensure segregation of Specialized Center for Obesity gan a journey that today would Finally, I could not fail to revisit staff and, especially to those in 2020, information about the cases of the disease and protect and Diabetes to the Paulista culminate in 123 years of com- the year 2020 without mention- who work on the front line, for rapid spread of a virus capable patients, doctors and employ- Unit, now located on the same mitment to the advancement of ing the commitment, dedication making our Hospital a place of causing serious respiratory ees. We increased the number floor as the recently opened public and private health. and resilience of our teams. where life is valued, something disease in mainland China was of ICU beds according to the Specialized Center in Diges- fundamental in a pandem- already beginning to concern demand in all units; we changed tive System, fully consolidating A century later, we continue to In addition to the results of the ic that, in 2021 already killed international health authorities. some care routines maintaining our performance in this area be guided by this same com- Hospital, I can only look positive- thousands of Brazilians. For Although we started preparing humaneness, security and com- of emphasis. Another highlight mitment through our Social ly for the year that has passed 2021, we hope to be able to relatively early for the arrival in passionate care; throughout the of extreme relevance was our Responsibility pillar, which works by counting how many lives were continue with resilience, be- Brazil, for sure we, like all other year we increased the number indicators in the treatment of towards forming partnerships of saved in our facilities, how many ing sure that this will certainly health organizations, companies of employees with 474 hires; we Covid-19, with outcomes and shared value to contribute even stories will continue - all thanks mean an important chapter of and the society itself, experi- established connections with results for the patient compara- more to Brazilian public health. to the hard work of our multipro- our trajectory as an Institution. enced in our country a rapid government officials and special- ble to those of the best interna- fessional teams. advance of Covid-19, already as ists to better understand the dis- tional hospital centers. On the one hand, we adapt- a pandemic. ease and its progression; and, as ed our actions in the Support I join our patients and their members of the Covid-19 Brazil In relation to Innovation, Re- Program for Institutional Devel- families to say a resounding Adopting a plan with clear Coalition, we directed our efforts search and Education, we opment of the Unified Health thank you to each employee pillars and an operational and in Innovation, Research and continue to progress in studies System (Proadi-SUS) for the and member of the clinical financial structure capable Education to tackle the biggest and incorporation of technol- 2018-2020 period to disseminate of dealing with adversities, in pandemic in our recent history. ogies, expanding our offer of knowledge and to meet needs addition to a team truly passion- postgraduate courses in the related to the pandemic with ate about life and obstinate in All these measures in addition areas of emphasis: Oncology services such as TeleHAOC - in achieving the best outcomes for to the rigorous monitoring of and Digestive System. Our which our teams offered a portal all patients, our Hospital became the strategy's execution, with International Research Center for associate discussion of cases a cutting edge center for com- emphasis on projects in the and the Center for Innovation with public sector professionals. bat, research and assistance on areas of emphasis, business and Health Education have also Covid-19, without interrupting protection, contribution and yielded good results, from the We were also able to act di- the care of other illnesses. impact on Brazilian health. De- training and qualification our rectly on the emergencies of spite this scenario, our net rev- own and market profession- Covid-19 through our Social Immediately, we made a series enue grew slightly compared als to the testing of disruptive Institute, which took over the of adjustments in the occupation to the previous year, but much solutions and dialogues with operation of the Campaign and circulation in our units in of the progress was in ramp-up startups that seek to revolu- Hospital (Hospital Vitória), in and strengthening operations - tionize the health market. addition to the activities al- as in the case of the Vergueiro ready carried out by Complexo We invested Unit, which had a 60% raise in We believe that every organiza- Hospitalar dos Estivadores to revenue. tion has a duty to contribute to face the disease in the Baixada in research, the development of its commu- Santista. The Social Institute In the Private Health pillar, I nity. It was from this ideal that also during the pandemic led innovation and highlight in 2020 the expansion our founders courageously be- the opening of AMBESP - Am- of outpatient and oncology bulatório Médico de Especial- health care to face services at the Vergueiro Unit, idades Dr. Nelson Teixeira, our the pandemic the process of transferring the most recent achievement in public equipment operation. Paulo Vasconcellos Bastian CEO 12 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | OUR HOSPITAL 13

IN THIS CHAPTER > Timeline > Our units > Business model > Corporate governance > Ethics, integrity and risks Our

GRIHospital 102-1, 102-2, 102-3, 102-5

WE ARE A CENTURY-OLD INSTITUTION AND AT THE SAME TIME COMMITTED TO HIGH PERFORMANCE AND INNOVATION IN HEALTH CARE

1. 14 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | OUR HOSPITAL 15

Organizational activities are - Ambulatório Médico de Espe- ciently; and took good care of based on the pillars of Private cialidades Dr. Nelson Teixeira, in the business, seeking to control MISSION GRI 102-16 Health (through the Paulista, Baixada Santista, in addition to the natural risks of the context Be precise and humane to ensure the best expe- Vergueiro and Campo Belo the beds to face the Covid-19 and impacts on the revenue rience and health outcome for the patient units); Innovation, Research pandemic at the Campaign Hos- generation and profitability of and Education (production and pital Complexo Hospitalar dos the Hospital. dissemination of knowledge Estivadores (Hospital Vitória), Founded 123 years ago by VISION GRI 102-16 through research and provi- located in Santos. At the end of the year, the German-speaking immigrants Full health care takes place in harmony between sion of education at technical, Hospital had a net revenue of in the city of São Paulo (SP), knowledge and compassionate care. undergraduate and postgradu- The Strategic Plan focuses on R$ 852.4 million, slightly above Hospital Alemão Oswaldo Cruz ate levels); and Social Respon- evoking the points that stand 2019. The revenue profile has is an integrated center of high sibility, through the Hospital's out in the business model and changed substantially with complexity, offering patient VALUES GRI 102-16 performance in programs and the historical attributes of the the reduction of elective pro- care, treatment, teaching and • PATIENT SAFETY - Attention projects to improve Brazilian Institution - such as the com- cedures and the increase in research in health with empha- and precision to deliver the essential for public health and Instituto Social bination of medical excellence hospitalizations of patients with sis on Oncology and Digestive our patients: safety. Hospital Alemão Oswaldo Cruz and relationships guided by Covid-19. On the other hand, System. (Social Institute). humaneness and compassion- in line with the strategy, the • COMPASSIONATE CARE - It is through human ate care - to prepare for growth expressive growth in Vergueiro The Institution, which is a ref- relations The Social Institute is responsible with goals, indicators and Unit and in the area of Innova- erence in Latin America, has as , touching and looking that the most for managing Complexo Hospita- projects in different fronts. The tion, Research and Education its hallmarks the commitment profound medicine is practiced. lar dos Estivadores and AMBESP long-term vision is in line with reinforces the consistency of to always do better - the motto the challenges of the health the results of the year with the Immer Besser, in German - and • TRUTH - Trust is our means and credibility our market and the trends and Hospital's growth plan. the philanthropic profile, guided end. We are righteous with ourselves and the transformations of highly com- by a business model that aims world around us. plex medicine and care. to generate shared value and promote a positive impact on • COLLABORATIVE PROTAGONISM - The The expansion path, believing in Brazilian health. For this, it has Hospital is a living organism. Each one of us new models of relationship with more than 3,300 direct employ- need to perform their role and, above all, have the market and strengthening ees and 4,500 physicians and initiative, regard each other and work together. Hospital Alemão Oswaldo Cruz dentists in its active registered brand, prepared the Institution to clinical staff. • INNOVATIVE TRADITION - Preservation of the deal with the challenges brought culture and historical landmarks of a centu- by the pandemic of the new ry-old hospital that knows how to reinvent coronavirus, formally announced itself in order to continuously evolve. by the World Health Organization (WHO) in March 2020.

Having the lives and safety of its employees, patients and medical staff as priorities, the Hospital engaged in research and therapies to face the disease; adapted all of its processes and protocols; invested in the dissemination of qualified information to deal with the pandemic effectively and effi-

Reception of the Paulista Unit 16 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | OUR HOSPITAL 17

Inauguration of the International Inauguration of the Research Center and the Health Timeline Center Specialized in Innovation and Education Center; Oncology, second re-ac- structuring an additional 10,880m2 to creditation by the JCI, expand the capacity of Vergueiro Unit. revision of the Strategic Instituto Social Hospital Alemão Electronic pre- Plan, renewal of the Mis- Oswaldo Cruz wins public call to The Hospital was a pioneer scription is adopt- sion, Vision and Values Inauguration of administer AMBESP - Ambulatório in the installation of a ed by the Hospital. and inauguration of the Tower B, with Médico de Especialidades Dr. Nelson linear accelerator used in Premium service. 14 floors and Teixeira. radiotherapy. equipped with helipad. Outbreak of the First World War and Celebration of the 120th anniver- postponement of the sary of Hospital Alemão Oswaldo construction work. Establishment of Name is once again Cruz, launch of the new brand, start a partnership with changed to Hospital The Education pillar of operations at Vergueiro Unit, Institution adopts the the Ministry of Oswaldo Cruz. is strengthened start of the first undergraduate name Hospital Alemão Health to imple- with the inaugura- Nursing class and implementation Oswaldo Cruz. ment Proadi-SUS. tion of the Techni- of electronic dispensaries, decen- Foundation of Beginning of cal School of Health tralizing the process of dispensing the Associação activities and Education (ETES). medicines in ICUs and inpatient Hospital Allemão construction units and implementation of the on September of the garden Hospital Alemão Oswaldo Cruz® 26th. pavilion. Care Model.

1905 1922 1941 1960 1980 1997 2006 2009 2012 2014 2016 2018 2020

1897 1914 1923 1942 1972 1991 2002 2008 2011 2013 2015 2017 2019

Inauguration of the The Hospital is accredited for the fourth School of Education time by JCI, inauguration of the Brain in Health Sciences and Spine Tumor Specialized Center, Acquisition of Expansion with (FECS), of the Center acquisition (and pioneering operation 23,550m2 of land in the Tower D, building Specialized in Obesi- in Latin America) of the linear particle Avenida Paulista with restaurant ty and Diabetes and accelerator Halcyon ™ and consolidation region. Change, as required and leisure and creation of Instituto of drug traceability digitally in the by the government, social area. Investments in mod- Social Hospital Alemão medication process from its origin to the of the name to ernization, elec- Oswaldo Cruz. bedside. GRI 102-10 Associação Hospital Certification from tronic controls and Rudolf Virchow. the Joint Commis- completion of the sion International Beginning of the Inauguration of the Center operating room. (JCI). implementation of the Specialized in Digestive System Construction Strategic Plan 2016-2020; of the Hospital Medical insurance Instituto Social Hospital Incorporation of the Center starts. On the centenary anni- companies start Inauguration of Tower Alemão Oswaldo Cruz Specialized in Obesity and Diabetes versary of the Hospital, to operate in the E, with 25 floors, and wins public call to manage to the Paulista Unit the three-story garage Brazilian market. first JCI re-accredita- Complexo Hospitalar and a new entrance hall tion process. dos Estivadores; official are inaugurated. The Social Institute starts to manage opening of AMBESP + extension of Estivadores' Vergueiro Unit. contract for the management of the Campaign beds in Santos. 18 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | OUR HOSPITAL 19

Our Units GRI 102-4, 102-6, 102-7

PAULISTA UNIT

Located in the heart of São Paulo, the Paulista complex focuses on patient care, diagnosis and research in highly complex medicine. Equipped with Gen- eral Adult Emergency Service; Cardiology, Neurology and Sur- gery Emergency; laboratory and imaging diagnostics services; Outpatient Units and Specialty Centers; Center Specialized in 2 Oncology; Center Specialized in · 96,000m in Urology and Robotic Surgery; built-up area Centers of Cardiology, Endos- copy, Nephrology and Dialysis, · 306 Orthopedics, Brain and Spine Tu- hospital beds mor Surgery; Check-up Center; Hernias Unit; and Surgery Center, · 21 operating rooms among other specialties. At the · 44 ICU beds* end of 2020, a Center Special- ized in Digestive System was also opened at the unit, offering clinical and surgical care. This inauguration was an important milestone for the Institution, which was also highlighted in the STRUCTURE TOWER B TOWER D ranking of the best Brazilian hos- · Surgery Center · International · Employee Health and Safety Research Center Center (CASSC) - occupational pitals in the area of gastroenter- TOWER A · Cardiovascular Intervention Center · Inauguration of the Specialized focus ology featured in the American · Diagnostic Imaging Center · Clinical Specialties Center Center magazine Newsweek. The publi- · Center Specialized in Oncology for Digestive System · Inpatient Units TOWER E cation highlighted hospitals that · Center Specialized in Orthopedics » Esophagus and Stomach Unit · Noninvasive cardiology · Inpatient Units are references for the experience · Clinical and Orthopedic Emergency Care » Bile Ducts · Day Clinic and Pancreas Unit · Surgery Center Nephrology and Dialysis of their clinical staff, state-of- · » Liver Unit · Endoscopy and Colonoscopy - · ICUs and · Surgical Specialties Outpatient Unit the-art facilities, best diagnostic Specialty Center » Coloproctology and premium service rooms · Clinical Neurophysiology Intestines Unit systems, effective treatments · Convenience and Living area · Convenience and Living area » Hernias Unit and a high level of care. · Brain and Spine Tumor Specialized Center for Physicians for Physicians · Specialized Center · Cardiology · Material and Sterilization · Living area for Obesity and Diabetes for patients PAULISTA UNIT · Clinical Medicine Center (CME) · Specialized Center · Physicians' Restaurant · Auditorium for Urology

· Specialized Center *Data refers to installed capacity. for Robotic Surgery Due to the evolution of the pandemic, other TOWER C · Onco-hematology Unit beds were opened throughout the year, which · Emergency Department changed the data (presented in other parts of · Employees' restaurant, gym · Cardiology, Neurology and this report - see chapter Coping with Covid-19). and leisure and social area Surgical Emergency Unit

· Surgery Center SÃO PAULO SANTOS/SP

VERGUEIRO UNIT CAMPO BELO UNIT SPECIALIZED CENTER FOR HEALTH INNOVATION AND COMPLEXO HOSPITALAR CAMPAIGN HOSPITAL In 2020, upon a consistent ramp Located in the south region OBESITY AND DIABETES EDUCATION CENTER DOS ESTIVADORES VITÓRIA - EXCLUSIVE up process with an increase of of São Paulo, it has more than The unit specialized in serving Located on Avenida Paulista, Located in the city of Santos COVID-19 CARE 60% in net revenue compared to 1,400 m2 of built-up area and one of the areas of emphasis was it is a space that houses an and managed since 2017 by Acting to combat the Covid-19 the previous year, the unit inau- 15 rooms, with various services incorporated at the end of 2020 incubator and accelerator Instituto Social Hospital Alemão pandemic, through the expansion gurated an outpatient building that include: in the Paulista Unit. Until this for startups, a data science Oswaldo Cruz, the service is a of the contract signed for the with R$ 2.5 million in investments, reference for pregnant wom- • Infusion Center year, it was in a segregated space laboratory, 3D printing management of Complexo Hos- which will allow an increase with 578 m2 of built-up area, island, education station and en and high-risk newborns. pitalar dos Estivadores, Instituto of over 100% in the volume of • Clinic specialized in dizziness close to the hospital complex development of solutions in Among their activities there is Social Hospital Alemão Oswaldo patient care. The construction virtual reality and augmented the Center for Elective Surgery, Cruz incorporated the man- • Personalized check-up - is 10,600 square meters larger reality, training and realistic diagnostic services and outpa- agement of Campaign Hospital “Bespoke” in relation to the 36,500 m2 of simulation laboratories and tient medical care. In 2020, it Vitória, which receives patients built-up area and in operation also began to provide care to • High Endoscopy and workshops for the development from Santos’ emergency services since 2017. of digital solutions for health patients with Covid-19 in Baixa- Colonoscopy Service TECHNICAL SCHOOL and referenced from all the cities da Santista. of Baixada Santista and other The unit has 69 offices in to- AND COLLEGE • Surgical Day Clinic 2 municipalities. tal and centers specialized in 790 m 11,600 m2 of built-up area Continuing the expansion pro- of built-up area Women's Health, Cardiology and • Vaccination Service cess of the Institution's educa- 110 beds Surgical Specialties. 190 active beds • Specialized Memory Clinic tional area, the headquarters of the Technical School and College The innovative business model is 40 ICU beds of the Hospital were transferred 66 ICU beds based on cost predictability and • Consultations in the to a commercial building on Av. (10 neonatal + 16 adult + 40 focus on the best patient experi- specialties of medical clinic, Paulista. The initiative reinforces Covid-19) ence. In addition to the Special- general surgery, cardiology, the organization's purpose of ized Center for Oncology and the geriatrics, dermatology, being a pioneer contributing to 4 operating rooms Specialized Center for Obesity gynecology, rheumatology, the progress of health in Brazil and Diabetes, the new Vergueiro gastroenterology, through Education, proposing building will now host the Com- coloproctology, hepatology, solutions for the health today prehensive Health program. ophthalmology, orthopedics, otolaryngology, nephrology, and in the future. AMBESP – AMBU- 232 hospital beds plastic surgery, urology, LATÓRIO MÉDICO DE neurology, psychiatry, 8 classrooms 12 operating rooms psychology, pneumology, ESPECIALIDADES DR. nutrition and speech therapy NELSON TEIXEIRA 30 ICU beds 3 laboratories (IT, Patient Care Practices and Virtual Reality) Located in the Macuco neighborhood in Santos and 980 m2 of built-up area managed by Instituto Social since 2020, AMBESP is a high- resolution clinic that offers 34 medical specialties, eight non- medical, diagnostic center and surgical procedures.

4.4 thousand m2 of built-up area *Data referring to installed capacity. Due to the evolution of the pandemic, other beds were inaugurated 5 floors throughout the year. More information in the chapter Coping with Covid-19 22 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | OUR HOSPITAL 23

BUSINESS MODEL Here is a summary of our value Immer besser creation process, from the capitals we use to the impacts we High-performance medicine and a vocation for care Businesscause. model

CAPITALS WE USE (our assets) KEY ACTIVITIES OUTPUT OUTCOMES

(the value we deliver) (our impacts)

Financial capital that can be Centennial hospital group Private Health High performance medicine reinvestment in technology, that preserves the German High complexity hospital with an that delivers the best infrastructure and employee culture and reinvents itself emphasis on Oncology and the development and compensation to evolve continuously. Digestive System and focused on experience and the best Modern structure, high- quality and patient safety health result for Creation of a disruptive payment tech equipment and high the patient model with cost predictability standard of medical care covering diagnosis, treatment and . Providing more people post-discharge and is therefore Innovation, Research more sustainable for payors and Education with excellence in medicine, It creates and disseminates knowledge compassionate care through innovation, research and ed- and cost predictability. Improved public health and ucation. Empowers talents and sup- expanded access to both public ports the development of professionals Sharing knowledge and and private healthcare; improved through technical, undergraduate and best practices with other graduate programs organizations public hospitals Philanthropic institution with financial capital from Sub-products Satisfaction of patients private services, operators Social Responsibility and family members and health and self- Contributes to the excellence of Brazil's Na- management plans. All funds tional Health System (SUS) through partner- Health care management model for obtained are reinvested in the ships of shared value for the management of companies, with health promotion, organization itself public institutions and several other contri- diagnosis, treatment and post- butions to the strengthening and systemic discharge, as well as the use of advancement of Health in Brazil integrated information throughout the health chain

A multidisciplinary, qualified Hospital Alemão Oswaldo and integrated team focused on Cruz®Care Model Information for society providing full health care, combining a owned model, which provides on healthy habits knowledge and compassionate care. individualized, comprehensive and disease prevention Quality partnerships with suppliers, and humanized assistance for researchers and specialists. Cost- patients and family members Waste treatment and effectiveness and excellence in in the care center recyclingWaste treatment Knowledge generation, operations and recycling research activities, diffusion + hospital waste of innovation + hospital waste + reclaimed+ waterreclaimed water 24 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | OUR HOSPITAL 25

Corporate governance Executive Board GRI 102-18 Audit Board Holding positions that cover • 7 members on the Organized as a non-profit, phil- the main areas of operation of anthropic association, Hospi- Members’ The Audit Board is a collegiate the Hospital, the group in- Executive Board tal Alemão Oswaldo Cruz has body of permanent operation cludes executives with experi- • 18 meetings held by a decision-making structure General Meeting formed by at least three and at ence in the health sector and the Executive Board underpinned by professionalism most six members. In compli- is responsible for ensuring the • in management, aligning the It is the main body and holds ance with the best governance Advisory execution of the business plan. 2 members on the conduct of its executives and ordinary meetings once a year practices, it operates inde- In addition to the CEO, the Clinical Board leaders with the mission and to elect the members of the pendently and reinforces the committees team includes Patient Care, • 48 meetings of the institutional values and by com- Board of Trustees and Audit Institution's adherence to legis- Medical, Operations, People & pliance with good governance Board, to discuss and vote on lation, internal and external con- Structured in 2020 with the Management, Innovation, Re- Clinical Board held and national and international the financial statements of the trols, as well as applicable tax purpose of supporting the basis search & Education and Social in 2020 management. previous year, among other and accounting standards. As for the decisions of the Board of Responsibility directors. matters provided for in the a body responsible for inspect- Trustees, the committees focus At the end of 2020, the Institution's Bylaws. ing the executive management, on themes defined according to In accordance with instruc- Institution had 120 associate the Audit Board reviews the their competence and issue opin- tions issued by the Federal members. This group provides • 120 members economic and financial balance ions and analyzes relevant to the Board of Medicine (CFM), reflections on the business, • 1 meeting in 2020 sheets of the Hospital and is in future of the Institution, there- members of the Clinical Board its origins, purpose and areas charge of other matters provid- fore, not having a deliberative are also appointed by an open of impact and growth in the ed for in the Bylaws. character. All advisory commit- clinical body. context of Brazilian health. tees are coordinated by mem- • 4 members bers of the Board of Trustees, In recent years, the Hospital's • thus ensuring compliance with governance model has under- 5 ordinary meetings the strategic plan and guidelines gone intense renovation. In in 2020 defined by the Board of Trustees. GOVERNANCE AT THE line with the Strategic Plan, In 2020, the following Commit- SOCIAL INSTITUTE the idea was to strengthen the tees were created: Institution's brand positioning As it is a Social Health Organization of legal nature, in a highly challenging mar- • Audit and Risk the Social Institute has in its governance structure the ket, guided by competition in Board of Trustees Board of Directors, the Audit Board and the executive areas of private health growth Committee management, carried out by the CEO, with the support and structural changes in the Comprising a minimum of eight • 9 members - 5 members of leaders and managers active in the projects and units financing, costing and prof- and a maximum of ten members, • People Committee under management contract with public entities. itability models of hospital as provided for in the Bylaws, • 10 ordinary and businesses. the body is responsible for the 2 extraordinary - 5 members The Bylaws provides for nine members with terms general, political and strate- meetings • Strategy Committee of four years with the possibility of one reelection. The governing bodies of gic orientation of the Hospital. The chairman and deputy chairman of the Board of in 2020 - 4 members Hospital Alemão Oswaldo Furthermore, the Board must en- • Directors are appointed by Hospital Alemão Oswaldo Cruz are the Members’ sure the implementation of the Innovation Cruz. General Meeting, the Board of strategic plan, as well as moni- and Technology Trustees, the Audit Board and tor and evaluate the executive Committee The Audit Board is a collegiate body with three to six the Executive Board. In 2020, management. Members receive members, all founding members or permanent members. advisory committees were no compensation and in order to - 5 members added to these structures to be part of this Board they must • Research and The Executive Board can be composed of up to three the Board of Trustees in several be committed and have a vision Education Committee members. The latter is responsible for complying with areas of specialty. aligned with the Hospital, its the Bylaws and the resolutions of the General Meeting challenges and priorities. - 5 members and the Board of Directors. 26 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | OUR HOSPITAL 27

HOSPITAL ALEMÃO OSWALDO CRUZ INSTITUTO SOCIAL HOSPITAL ALEMÃO OSWALDO CRUZ

Board of Trustees Clinical Board Board of Directors

WEBER PORTO MARK ESSLE MARIA CAROLINA JULIO MUÑOZ KAMPFF JOÃO CARLOS VISETTI MARCELO OLIVEIRA GILBERTO MARIO PROBST MARK ESSLE BRUNO DE CARLI JULIO MUÑOZ KAMPFF RONALD SCHAFFER BRUNA JACOBINA CHAIRMAN DEPUTY CHAIRMAN DA COSTA MEMBER MEMBER DOS SANTOS TURCATO JUNIOR CHAIRMAN DEPUTY CHAIRMAN MEMBER MEMBER MEMBER MEMBER MEMBER CLINICAL DIRECTOR DEPUTY CLINICAL DIRECTOR

RODOLFO SPIELMANN FABIO MITTELSTAEDT MICHAEL LEHMANN RONALD SCHAFFER MEMBER MEMBER MEMBER MEMBER PAULO FÁTIMA SILVANA ANTONIO DA SILVA VASCONCELLOS FURTADO GEROLIN BASTOS NETO BASTIAN MEMBER MEMBER MEMBER Audit Board

Executive Audit Board Management

CHARLES KRIECK ERNESTO BEATE BOLTZ ROLAND GALLBACH CHAIRMAN NIEMEYER FILHO MEMBER MEMBER DEPUTY CHAIRMAN

MICHAEL LEHMANN ERNESTO NIEMEYER BEATE BOLTZ WEBER PORTO ANA PAULA NEVES Executive Board CHAIRMAN FILHO MEMBER MEMBER MARQUES DE PINHO DEPUTY CHAIRMAN CHIEF EXECUTIVE

PAULO FÁTIMA SILVANA KENNETH ALMEIDA ANTONIO DA SILVA ANA PAULA NEVES ALLAN JAMES PAIOTTI VASCONCELLOS FURTADO GEROLIN CHIEF OFFICER BASTOS NETO MARQUES DE PINHO CHIEF OPERATIONS BASTIAN CHIEF OFFICER FOR FOR INNOVATION, CHIEF MEDICAL CHIEF SOCIAL OFFICER CHIEF EXECUTIVE PATIENT CARE RESEARCH & OFFICER RESPONSIBILITY OFFICER AND INTERIM EDUCATION OFFICER FOR PEOPLE & MANAGEMENT 28 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | OUR HOSPITAL 29

Ethics, integrity and risks GRI 102-16; 103-2, 103-3 | 205, 205-3; 103-2, 103-3 | 418, 418-1; 103-2, 103-3 | 419, 419-1 greater risk and/or strategic for the Hospital. The area is also re- Hospital Alemão Oswaldo In 2020, the subject was sponsible for verifying incidents COMPLIANCE WITH THE Cruz's relations are based on strengthened in the organiza- of corruption. LGPD value of integrity. Relationships tional structure through the POLICIES & PROCESSES The Institution's preparation to meet all between doctors, employees, creation of the Legal and Com- In line with the plan established the requirements of the Brazilian General patients, governments, suppli- pliance Department, which for the year, the processes of The main management policy Data Protection Act (LGPD) started in ers and society are guided by integrates the processes of legal People & Management, Accounts related to the subject is the Ethi- 2020. The creation of the Privacy Policy clear guidelines in good faith follow-up and projects in ethics Payable, Purchasing, Pharmacy cal Conduct Handbook, available and its wide dissemination on the insti- and conduct, seeking to pro- and integrity at the Hospital. and Medical Transfer areas were to all areas in order to clarify tutional website were the first measures, tect the brand's reputation and This decision is in line with the audited. In 2020, as in previous doubts, provide guidance and ex- followed by steps to adapt processes avoid any ethical deviations in initiative to implement the ma- years, no cases of corruption plain responsibilities and impacts and conduct training for employees. In the conduct of the Institution's trix model in the management of were identified at the Hospital. of the employees' performance. the first half of 2021, more controls are daily activities. Hospital Alemão Oswaldo Cruz, planned to mitigate the risk of data leak- with leaders responsible for In another initiative of Hospital In 2020, new management poli- age. All actions aimed at promot- setting forth policies, guidelines Alemão Oswaldo Cruz towards cies were developed with the pur- ing ethics are guided by the and work standards applicable more controls and governance, pose of consolidating the culture Today, the topic is under the direct Integrity Program, carried out to the units that make up the the Institution took advantage of integrity, ethics and transpar- management of the Information Secu- in a transversal manner, with organization. of the adaptation process for ency in the Institution. They are: rity and Legal Departments. There is a direct engagement by the the Facilities and Security Man- Third-Party Transactions Policy, specific channel for patients to contact CEO; communication, training, The Internal Audit area is an- agement (FMS) chapter of the Conflict of Interest Policy, Confi- the Hospital and clarify doubts related policy dissemination, mainte- other relevant front, reporting Joint Commission International dential Channel Policy, Informa- to privacy. These structures are com- nance of channels for records, directly to the Audit & Risk Man- (JCI) to create, in 2020, a pilot tion Security and Data Protection plemented by the Data Protection work complaints and denunciations, agement Committee - one of project for the implementation Policy and Privacy Policy. committee, which meets periodically Ombudsman processes, Internal the advisory bodies structured of a continuous Corporate Risk and counts on the hospital's top man- Audit and Risk Management are in the year. Annually, the de- Management (non-clinical) All deviations and potential agement team. all linked to the program. partment executes a work plan process, which will be under the non-compliance with the Hand- aimed at areas and processes of Internal Audit area. book can be reported through the Confidential Channel - which is managed by third parties and ensures independence were accepted, against 491 re- of the process, secrecy, integri- cords in 2019 and 182 in 2018. ty and privacy of the records. Taking into account customers, Reports sent to the channel are the Ombudsman also accepts forwarded for analysis by the complaints and protocols. In We received 467 Ethical Conduct Committee, 2020, as in previous years, formed by the Chief Executive there was a record of cases (20 reports in the Officer and by the managers of in the year, against 33 in 2019 Internal Audit, Legal and Com- and 26 in 2018) of attempted Ethical Conduct pliance Department and People scams aimed at patients and Committee during & Management Department. The family members, requesting body analyzes the cases and if fake bank deposits on behalf the year necessary establishes corrective of the Institution. There were or disciplinary measures in joint no complaints by customers or INTRABEAM®, intraoperative decision with the leaders of the responsible agencies associated radiotherapy equipment Institution. In 2020, 467 cases to data leakage. 30 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 31

Strategy

IN THIS CHAPTER 2020 REPRESENTED A MILESTONE IN THE HISTORY OF > Planning, goals and indicators HOSPITAL ALEMÃO OSWALDO CRUZ AS WE ENDED A > Capital allocation STRATEGIC PLAN CYCLE, WHICH WAS IN PLACE SINCE 2016 2. > Sustainability agenda 32 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 33

al groups and the subsequent opening of more undergraduate RESILIENCE AND ADAPTATION the postponement of proce- Another important sector of this acquisition of hospital centers and postgraduate courses, the dures, elective surgeries and market is that of supplementary caused institutions such as Hos- inauguration of centers dedi- Data from the National As- outpatient care. health. Data from the National pital Alemão Oswaldo Cruz to cated to innovation & research sociation of Private Hospitals Supplementary Health Agency strengthen their competitive- and advance in the generation (Anahp) point out that despite There was also a change in (ANS) indicate an increase in ness with a more solid brand of knowledge and education - the growing demand caused hospitalizations: in 2020, those the number of users of private positioning, based on attributes and also in Social Responsibility by Covid-19 peaks throughout related to infectious diseases plans (+ 1.5%), even with the perceived by patients, clinical with important achievements 2020, Brazilian institutions had - which include patients with negative economic scenario of staff and operators and a focus in the administration of public a drop in their financial results, Covid-19 - more than doubled, 2020. Operators closed the year on specific areas of medicine. health services that reinforce according to the association's while other areas had a reduc- with a consolidated increase in This planning was in fact deci- the Institution's impact on the observatory - which represents tion or stabilization in relation profit, stable levels of default sive to deal with the challenges Brazilian society. 118 hospital centers. to the previous year. and even with suspensions in of the Covid-19 pandemic in a the second semester, they may The five years were decisive for resilient manner. Equipped with knowledge, In addition to pointing out the According to Anahp, the con- have a reset of the adjustments the realization of growth plans, advances and new challeng- cycles of the pandemic and its solidated Ebitda margin for the in 2021. In December 2020, the strengthening of the brand and The strategy in recent years es in its sector, the Institu- impact on emergencies and year had a significant drop of supplementary health sector to- investment in fronts such as has prioritized investments tion is already working on its emergency departments, with 4.3 percentage points in com- taled 47,564,363 users in health Innovation, Research & Education and actions that reinforce the new Strategic Plan 2021-2025 the assistance to suspected parison with the year 2019. care plans, the highest number and Social Responsibility, prepar- Institution's brand and position- conducted by the Board of cases and diagnostic confir- The scenario showed signs of since January 2017. ing the Institution for an increasing in the health market. We Trustees and the Executive mations growing again as from recovery at the end of the year; ingly challenging environment in highlight the innovations in the Board, whose focus will be on October 2020 the technical however, the upsurge in the This business area exposes the Brazilian health market. relations with operators and strengthening the brand, in opinion of Anahp shows that pandemic in the first quarter of institutions such as Hospital the further development of the partnerships, in the patient's there was a drop in average 2021 points to new impacts on Alemão Oswaldo Cruz to a Several changes taking place in areas of emphasis. It was also experience and gains in op- bed occupancy rate (which fell the sector, including pressure on series of challenges and oppor- the Brazilian health have been a relevant cycle in Innovation, erational efficiency with high from 77% to 67.7% between hospital services and the provi- tunities. In the last few years consolidated in recent years. Research & Education - with the resolution and performance. 2019 and 2020), as a result of sion of medicines and supplies. investments have been made Old debates, such as the inter- on several decisive strategic vention of digital culture in the plans to keep the Institution care and treatment processes, well positioned in a context the adoption of data science such as that of 2020. On the tools in population manage- one hand, the focus on knowl- ment and care protocols, the edge generation and dissemi- evolution of telemedicine and nation strengthened the rela- the systemic look at the pa- tions of the Hospital with other tient focused on outcomes are players in areas of innovation, some of the trends that have research and health education. deepened in the context of the This can be noticed with the Covid-19 confrontation. participation of the Hospital in the Coalition Covid-19 Brazil, Another significant aspect of an integrated front of studies the Brazilian private health mar- to understand the disease and ket was the inclination towards the infected population, as well consolidation in the last decade. as with the efforts made in the The arrival of large internation- research and innovation centers of the Hospital.

Vergueiro Unit 34 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 35

AREAS OF EMPHASIS: ONCOLO- GY AND DIGESTIVE SYSTEM INDICATORS - VOLUMETRY IN THE EMPHASIS AREAS The areas of emphasis are In association with population into the area of the Digestive one of the first focuses of the aging and the expectation of a System in the building of the institutional strategy and in 60% increase in cases of cancer in Paulista Unit. Cancer Surgeries* Surgeries at the Specialized 2020 yielded significant results. the coming years (data from the Center for Gradually, the volume and indi- World Health Organization), a lev- Notwithstanding other important Obesity and Diabetes** 4,049 cators of research, production el that reaches more than 80% in and traditional areas of the In- and innovation in the areas of developing countries, a dedicated stitution, the two segments had 3,965 276 Oncology and Digestive System Oncology center was opened in been showing consistent growth. 3,964 have been standing out - in line 2015 and in 2020 it expanded However, the Covid-19 pandemic 295 with investments made in the outpatient service to Vergueiro impacted some specialties and centers of specialties and areas Unit, in order to further extend subspecialties, due to the lower 655 related to them. the coverage of healthcare and demand for visits, exams and, medical services. especially, elective or tracking/ Oncological Consultations* identification procedures of pa- In the area of the Digestive thologies (see charts). Endoscopies *** 10,222 Check out our System, a highlight for the year 2020 was the implementation Other relevant fields of invest- 14,856 15,660 performance in of the Specialized Center for ment, which interface with the 11,521 Digestive System, the result areas of emphasis and new 16,109 other areas and of investments and works to technologies and therapies are strengthen the care offered neurology, which registered 596 11,197 specialties in the by the Hospital to patients in surgeries in 2020, higher than Indicators Panel, this segment. In addition, the the previous year, and robotic Digestive Surgery* Specialized Center for Obesity surgery with 235 procedures and Diabetes was integrated performed during the year. Colonoscopies*** p. 72 4,010

4,527 11,579 3,799 11,641

7,424

Consultations at the Specialized Center for Obesity and Diabetes** Reference

6,226 2018 2019 2020 8,346

6,666

* Paulista and Vergueiro Units Inauguration of the Specialized ** Paulista Unit Center for the Digestive System *** Paulista, Vergueiro and Campo Belo Units 36 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 37

Human development Our targeted action: Attract, retain and qualify 4 employees of the Institution, strengthening the Planning, goals and indicators Operational efficiency attributes of engagement, innovation and col- Our targeted action: Improving laboration among teams At the same time we had the ing of the Hospital; their imple- next five years (2021-2025), for 2 the patient experience, delivering completion of the 2016-2020 cy- mentation and responsibility the entire Institution. Further- the best result with cost-effec- WHAT WE HAVE ACHIEVED: cle of Strategic Planning, the year are under the executive boards, more, the specific strategy in tiveness, quality and safety in the prompted us carefully analyse leaders who must inspire their the area of Innovation, Research processes > Increase of 30.41% in the total number of the indicators adopted to mon- teams to abide by and engage & Education and the planning of employees from 2016 to 2020 itor the progress of the Institu- with business priorities. Instituto Social Hospital Alemão WHAT WE HAVE ACHIEVED: tion's long-term plans. Oswaldo Cruz was continued. > We received the Great Place to Work badge. An Different areas, including those Important drivers and lessons > Increase of 2.5 percentage award for the best companies to work for In the last five years, Hospital of business intelligence, finance, learned in recent years, such points in the Net Promoter Alemão Oswaldo Cruz set forth transformation, information as the evolution of the matrix Score (NPS)* eight strategic pillars to ad- technology and operations, ac- structure - increasingly im- Social responsibility vance in the generation of val- company the execution of the portant in the face of business > Extension of the Emergency Our targeted action: Contribute to Brazilian ue. The Board of Trustees was main strategic projects. expansion movements - and the Service 2 operating hours to 24h 5 health through public-private partnerships and in charge of the identification of strengthening of competitive agreements, working with the Ministry of Health such pillars, which represent the During 2020, discussions were differentials in the areas of em- > Opening of drive-thru for PCR and local governments vision of the associates and the initiated to reformulate the phasis, should be the pillar for testing long-term and perpetuity read- Strategic Plan, now within the the next five-year period. WHAT WE HAVE ACHIEVED:

Expansion and Coverage > Two public calls won by the Social Institute: OUR STRATEGIC PILLARS Our targeted action: To grow in 2016, for the administration of Complexo And our achievements in the 2016-2020 cycle 3 organically and inorganically Hospitalar dos Estivadores, increasing the number of beds, and in 2020, for the administration of advanced units and partnerships Ambulatório Médico de Especialidades Strengthening the brand WHAT WE HAVE ACHIEVED: with the public and private sectors Dr. Nelson Teixeira - AMBESP Our targeted action: Increase 1 investments in communication > Presentation of new market WHAT WE HAVE ACHIEVED: > Implementation of structural projects for the and marketing and reinforce the positioning SUS (Brazil’s National Healthcare System) with Institution's presence and role in and logo after > Expansion of Vergueiro Unit, coverage throughout the national territory the media, capturing potential and branding work with a new outpatient building current patients and being a pref- and arrival > Elaboration of 27 strategic maps for the state erence among the clinical staff > Significant increase of the Specialized Center health departments, and restructuring of 27 in the Hospital's presence and rel- for Oncology and the public hospitals from the point of view of evance on social media: 1,896,818 Specialized Center for patient care processes PRESENCE ON followers on Facebook, LinkedIn Digestive System SOCIAL MEDIA and Instagram. In 2020 alone > Infection reduction in 24 hospital ICUs across the Institution had 352,790 > Increased impact and presence the country FACEBOOK new followers of the brand in public health Dec/2015: 137,422 followers through the Instituto Social > Qualification of bariatric surgery processes in Dec./2020: 1,555,607 followers > Independent audit study shows Hospital Alemão Oswaldo Cruz, 21 Brazilian hospitals a rapid ascension regarding which manages public facilities LINKEDIN visibility in the press - in Santos (SP) > With regard to innovation and research, Dec./2015: 17,469 followers 8th (2016) x 3rd (2020). scientific articles related to the analysis of cost- Dec./2020: 295,120 followers effectiveness of medicines were published and 31 > Reputation research in 2017 clinical protocols were delivered to the Ministry Total engagement*: 413,689 detected advances in Top of Mind *NPS started to be counted in 2017 of Health, together with 83 systematic reviews, (press and population). two methodological guidelines, one in technical- *Total engagement considers the sum of likes, comments and shares scientific opinion and the other in a systematic review of randomized clinical trials. 38 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 39

BED TURNOVER Management Definition: it indicates the relationship between the speed, effi- Innovation, Research & Education ciency and bed occupancy at the Hospital. It is calculated from the Our targeted action: Encourage the produc- indicators* number of discharges/number of beds x number of months. 6 tion and dissemination of knowledge within and outside the Institution, through the Analysis of 2020: the main challenge of the year was due to the provision of technical, undergraduate and In connection with its strategic pandemic, resulting in less bed turnover and difficulties in improv- graduate programs; study of incorporation pillars, the Hospital manages a ing the Institution's performance. of new technologies; development of new set of key performance indicators solutions and products for health through al- (KPI) that signal progress in areas 2018 2019 2020 liances with startups and large organizations; of excellence, knowledge creation, Paulista Unit 5.28 6.07 5.55 and increased participation of this pillar in economic performance, financial the business health and human development. Vergueiro Unit 3.7 5.7 4.3 Check out some of these KPIs on WHAT WE HAVE ACHIEVED: the following pages and their evolution year by year: SHARE OF AREAS OF EMPHASIS ON REVENUE (%) > 429% increase in net revenue in the area Definition: points out the economic and financial result of the Hos- from 2016 to 2020 pital linked to the areas of Oncology and Digestive Diseases

*The strategic indicators associated with Med- > Structuring of the International Research ical Development programs and actions (%) 2020 Analysis: Revenue from ICU admission increased in connec- Center and the Center for Innovation and were not reported because such initiatives are tion with the demands of the Covid-19 pandemic, which reduced under review Health Education the representativeness of the areas of emphasis

2018 2019 2020

49 48 45 Relationship with physicians Relationship Our targeted action: Building relationships of with operators 7 trust, engagement and mutual development 8 Our targeted action: Make the rela- with the active registered clinical staff, includ- tionship between the Hospital and RESEARCH IN EMPHASIS AREAS ing fostering research and valuing excellence its partner operators more efficient, Definition: total research protocols and projects linked to areas of balanced and with mutual gains, emphasis WHAT WE HAVE ACHIEVED: reducing dependence and seeking joint cost-effectiveness solutions 2020 analysis: even with the pandemic, the Institution has ad- > 40% increase in active registered clinical vanced in studies related to areas in line with its strategy staff from 2016 to 2020 WHAT WE HAVE ACHIEVED: 2018 2019 2020 > New model of medical relationship, with > New models tested with 10 15 20 dedicated programs and incentives operators, with price for engagement in research predictability, outcome and care and knowledge actions coordination AVERAGE ACCOUNTING RECEIVABLES PERIOD > 26% increase in the percentage Definition: it indicates the number of days for the Institution to of revenue (Paulista and receive credit for the services rendered Vergueiro Units) derived from closed packages linked to 2020 analysis: the number has remained relatively stable com- standard protocols for patient pared to previous years profiles and clinical conditions 2018 2019 2020 PMR** 129.52 123.18 118.21

**PMR (not discounting Estimated Losses on Doubtful Credits - PECLD): accounts receiv- able/total net revenue x days. 40 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 41

GRADUATING STUDENTS FROM COURSES IN THE AREAS STAFF SATISFACTION (%) OF EMPHASIS Definition: satisfaction survey conducted with support from Great Definition: volume of students in undergraduate and graduate pro- Place to Work (GPTW) grams in the Institution's areas of emphasis Analysis of 2020: even with the challenges experienced in the year, Analysis of 2020: 32 graduating students from the Oncology Nurs- the percentage remained positive and stable, with an increase in ing graduate program, one graduate from Oncological Neurology relation to 2019 (medical graduate program) and two graduates from the medi- 2018 2019 2020 cal residency in Digestive Endoscopy, Onco-hematology: Clinical Practice in Lymphoproliferative Diseases and Pharmaceutical Assis- 70% 69% 73% tance in Oncology due to the pandemic, theoretical courses were transferred to virtual rooms, so they could continue by means of technology. In 2020, three new graduate programs were launched: PATIENT SATISFACTION – NPS (%) Digestive Endoscopy, Onco-hematology: Clinical Practice in Lymph- Definition: satisfaction measured by the Net Promoter Score oproliferative Diseases and Pharmaceutical Assistance in Oncology. (NPS), by SMS sent after discharge from the Hospital or via email

2020 analysis: the institutional indicator had a greater variation 2018 2019 2020 compared to 2019, but reached its highest level in the last three years - although the goal originally set for the year was 80% 49 39 35

2018 2019 2020 NPS 73.5% 73.0% 76.7% NET REVENUE (R$ THOUSAND) Definition: revenue obtained by the Institution

Analysis of 2020: despite the challenges of the period, the expan- INSTITUTO SOCIAL HOSPITAL ALEMÃO OSWALDO CRUZ sion of Vergueiro Unit and the high demand for hospitalizations and Definition: total patient care visits provided by public services ICU occupation boosted the generation of results by the Hospital managed by Instituto Social Hospital Alemão Oswaldo Cruz

2018 2019 2020 Analysis of 2020: the volume of patient care provided increased exponentially with the operation of AMBESP - Ambulatório Médico R$ 764,029 R$ 842,596 R$ 852,497 de Especialidades Dr. Nelson Teixeira

2018 2019 2020 ALLOWANCE FOR DOUBTFUL DEBTORS (R$) 19,054 23,071 97,834 Definition: the volume of funds not received that the Institution classifies as uncertain as to the receipt

Analysis of 2020: with the update of the policy related to the topic in 2019, the numbers were within the expected during the year

2018 2019 2020*

12 million (11.5 million)* 2.6 million

* Negative value due to a work to revise the PDD policy, generating reversal of the amounts provisioned. 42 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 43

Capital allocation HIGHLIGHTS OF THE YEAR

The year 2020 for Hospital Even so, the main works Alemão Oswaldo Cruz had planned for the year were main- been planned with a series tained including the renovation of investments and projects of the surgery center and the linked to the consolidation of delivery of the new Specialized the Strategic Plan. Much of the Center for the Digestive Sys- actions, however, were impact- tem, at Tower D of the Paulista ed by the Covid-19 pandemic Unit, as well as the integration R$ 31.5 6 new and - which resulted in the need for of the Specialized Center for emergency projects to increase Obesity and Diabetes in this million 3 restored the capacity of Hospital in the same unit, in addition to the Hospital Alemão Oswaldo Cruz Emergency Department of its outpatient and oncology expan- consolidated Capex in 2020, rooms units, to ensure good safety sion at Vergueiro Unit. including: The general renovation of the Surgical standards for doctors, patients Center of Paulista Unit added new and employees, to provide quick Investments for the year and effective responses in the totaled R$ 31.5 million. The rooms, the modernization of several treatment of the new corona- amounts include R$ 4.5 million • R$ 17.5 million spaces and the creation of a medical virus for infected patients and contributed to Information invested in works living area and dressing room allocate human, material and Technology, R$ 1.6 million for the and medical equipment financial resources in a strategic expansion of Vergueiro Unit and (engineering) at Paulista and way, following daily indicators R$ 25.4 million to other projects. Vergueiro Units and trends of the pandemic in Check out some highlights on Brazil and, specifically, in the city the following pages. of São Paulo. • R$ 0.3 million for digital modernization of the patient's journey R$ 12.4 • R$ 3.8 million at the Innovation million In investments in works at and Health Education Center Paulista and Vergueiro units, which started in 2020 and • R$ 2.5 million for finished early 2021 the expansion of the outpatient clinic of Vergueiro Unit

Surgical Center has a new lighting system 44 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 45

Vergueiro: pace of expansion

As part of the ramp-up process Today, there are more than of Vergueiro Unit, opened in the 1,200 bundled payment mod- second half of 2017, the high- els adopted at Vergueiro for lights in 2020 were the opening patients with health plans and consolidation of the new contracted with the unit - in outpatient building, the expan- addition to private patients. 70% 63% 68.8% 73% sion of the capacity of beds Since its inauguration, more was the average was the growth increase in is the forecast for the and the expansion of special- than R$ 443 million have been occupation of of the operation hospitalizations bed occupancy rate of ized services in Oncology to invested in the plan to expand active beds in 2020 between 2019 and the unit in 2021 the unit, among which are the service offer. at Vergueiro Unit 2020 in terms of bed Bone Marrow Transplant Area (BMT). Currently, Vergueiro Unit In order to improve the patient's occupation includes another area of em- experience with a complete phasis in addition to the ser- cycle of care, diagnosis and vices of the Specialized Center treatment, one of the planned for Obesity and Diabetes. projects was carried out during the year: the inauguration of an Based on a disruptive business outpatient building. The space model that takes into account received R$ 2.5 million in funds the current needs of the Bra- for renovations, equipment, fur- zilian health market and is niture and technology. In total, The Unit has continued to guided by preset protocols and there are 69 specialty medical expand strategic partnerships EXPANSION OF ONCOLOGY bundled payment models in all offices, 12 of which are co-work- with healthcare operators, specialties (except obstetrics ing models. In addition, the out- offering care services that Year by year, the Hospital increases its and pediatrics), as well as daily patient building has care lines are always guided by quality, capacity and its range of services in and global rates for exams, for specific areas, such as a safety and this model with cost the areas of emphasis. In the Oncol- clinical admissions and chemo- Specialized Center for Women's predictability that is disruptive ogy Department the main novelty of therapy, Vergueiro is a success- Health, another specialized in in the market. 2020 was the expansion of the area to ful bet on what the Institution Cardiovascular Health and the Vergueiro Unit, bringing to it the team believes is the natural way for Specialized Center for Obesity of the Specialized Center for Oncology operators and hospital centers and Diabetes. of Paulista Unit with new space areas to generate the best result and and infrastructure. In 2020, 671 patient outcome for the patient, with The goal is to increase the vol- visits were carried out at Vergueiro. efficient use of resources and ume of patient care per month excellence in adhering to proto- by 150%, with a raise of up to According to the operators' contracts, cols, guaranteeing care quality R$ 12.5 million in revenue from in addition to clinical visits, chemo- and safety. patient visits, in addition to the therapy services and laboratory and expected benefits in increasing imaging tests may be carried out at the volume of surgeries at the Vergueiro Unit. unit coming from the outpatient clinic. The new building now also hosts the Employ- ee Health and Safety Center (CASSC), previously located at Paulista Unit. 46 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 47

Sustainability agenda GRI 102-40, 102-42, 102-43, 102-44, 102-47

Adherence to commitments and Social and environmental agendas related to environmen- topics in line with the Hospital's tal, social and governance issues (ESG) is a challenge taken on by strategy Hospital Alemão Oswaldo Cruz. The Institution acts with responsibility and in line with its busi- Materiality included stages of ness model seeking to evolve in sector analysis, prioritization Diagnostic Imaging Center this journey by understanding its through consultations, consoli- of Paulista Unit most relevant impacts through dation of topics and validation dialogue with stakeholders. by senior leadership. The first step was the study of trends, Since 2016, the evolution in the key topics and recent changes integration of methodologies in the sector, based on policies, such as the Global Reporting research, data from entities and Investment in digital innovation Initiative (GRI) and the Inter- policies of the Institution. national Integrated Reporting The focus on innovation is at the Partnerships with national and In the middle of the year, during Council (IIRC) to the production The second stage involved center of the hospital's strategic international research centers, the Covid-19 pandemic, the of annual reports has stimulated two processes: an online agenda (read more on p. 36). In industries and renowned or- Institution deepened its dia- the development of materiality consultation with about 400 2019, the Innovation and Health ganizations, such as Microsoft, logue with startups in order to processes - the last one was entries from suppliers, indus- Education Center was inaugurat- are at the heart of the center's strengthen its ecosystem and, completed in 2019 and resulted try leaders, employees, clinical ed - celebrating the institution's efforts to develop data analysis thus, incorporate technologies in the definition key sustainabil- staff and health plan operators; 122 years with a clear commit- and modeling projects applied capable of improving the pa- ity topics for hospital communi- and face-to-face interviews ment to the digital market and to health and to seek ways to tients' digital journey. In 2020, cation and management. with executive directors, lead- its contribution to renewing the promote a more connected and the highlight was the launch of ers and representatives of the business model. multiplatform education. Anoth- a challenge focused on the Spe- sector. In the end, eight top- er pillar of action is the connec- cialized Center for Oncology - ics were mapped as the most tion with startups in the health the intensive use of technology relevant in the field of sustain- area, with possibilities for accel- to improve the experience of ability. Check them out on the erating business that are under those who use the services of next pages. development in the market. the Hospital. This focus is not exclusive to this specialty, but to all business fronts. 48 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Strategy 49

EXTENT OF IMPACTS* RELATED GRI STRATEGIC TOPICS MATERIAL TOPICS AMBITION CHALLENGES SDG GRI 102-40 DISCLOSURES** OF THE HOSPITAL

Quality and • Safe care based on the best • Engagement of the Clinical Staff in quality Managers 102-43 • Operational efficiency care safety evidence, considering the value actions and patient safety Employees 102-44 • Social Responsibility perceived by patients • Inclusion of the patient in the design of Patients 416-1 • Efficient, highly reliable processes, care processes (codesign) Health Operators 416-2 with waste reduction, with a central • Improvement of behavioral skills (soft Physicians 417-1 focus on patient and family care skills) Press 418-1 Providers 419-1 Competitors

Talent Training, professional • Engagement of professionals Executive Board 102-8 • Human development development and and academic qualification of developed by the Institution Managers 102-41 • Innovation, research employees and performance engagement • Recognition of Employees 401-1 and education management professional deliveries Patients 404-1 Health Operators 404-3 Providers

Collaboration in Offering quality service to the low- • Improvement of care for Executive Board 203-2 • Social Responsibility the development income population, in addition to the least favored population Press 413-1 • Innovation, research the service and contribution to the of health systems • Increased coverage and brand Providers and education development of Brazil's National and initiatives for reinforcement Healthcare System (SUS) Health Operators access to medical • Managing changes in treatment the supplementary healthcare market

Efficient economic Business model and revenue in the • New business model for Vergueiro Unit Executive Board 419-1 • Expansion and performance in the face of increased operations and the • Greater integration of specialties Coverage need to maintain service quality use of resources • Search for new partners and suppliers for the innovative model

Clinical staff Loyalty, benefits offered, • Greater involvement in the Physicians Institutional • Relationship engagement career plan and performance hospital's decision-making strategic indicators with Physicians assessment tools for physicians processes • Brand Strengthening • Proximity of the Medical Relationship area with the professionals • Encouragement to increase the bond with physicians

Relationship Operators' participation in the • Changing remuneration models Physicians 201-1 • Brand Strengthening with operators Hospital's revenue and maintenance of and agreements 201-4 • Relationship commercial relations 205-3 with operators 419-1

Innovation, Research Valuing of production, management • Improvement in information Executive Board Institutional • Innovation, research and Education and dissemination of knowledge, systems for data collection strategic indicators and education seeking innovation in health processes applicable to research • Brand Strengthening and technologies • Incentive to academic production within the Hospital

Environmental Efficiency in the use of natural resources • Consumption of water and materials Executive Board 302-1 • Operational efficiency sustainability and control of impacts, focusing on the (paper) 303-1 • Brand Strengthening issues of emissions/energy, waste and water

* The extent of impacts covers the main internal and external stakeholders that highlighted ** In this cycle, the Hospital chose to disclose indicators 201-3 and 401-2, the relevance of the topics during the consultation and prioritization process although they are not part of the materiality 50 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | COPING WITH COVID-19 51

COPING WITH COVID-19 CHALLENGES OF THE YEAR WERE FACED WITH INVESTMENTS IN TEAM AND PATIENT SAFETY, PROTOCOLS BASED ON SCIENTIFIC EVIDENCE AND DISSEMINATION OF QUALIFIED INFORMATION TO SOCIETY

IN THIS CHAPTER > Protocols and lines of care > Multiplatform communication 3. > Taking care of our team 52 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | COPING WITH COVID-19 53

Agile responses to fight the new coronavirus

Facing the greatest health emer- During the month of March, the gency of the century was a huge Executive Board together with challenge that all Brazilians and the Presidency formed a crisis all organizations had to respond committee focused on the pan- Our frontline to during 2020 - regardless of demic. And among the issues professionals whether they work in the health addressed in this committee field or not. there was the medical conduct that the Hospital would have to The resilience of Hospital treat its first patients infected Alemão Oswaldo Cruz was with Covid-19. In other words, tested in 2020 and it was a the situations in which a patient Protocols and lines of care milestone in our history. It re- would be admitted, the condi- quired preparation, planning and tions under which more or less Science was the basis from ic research and also respecting In turn, with regards to Social responsiveness in face of the invasive procedures should be which Hospital Alemão Oswaldo ethics - thus reinforcing the Hos- Responsibility, the uninterrupted worsening of the pandemic in performed and so on. Making Cruz established its protocols pital's commitment to science. In activities of the crisis commit- São Paulo and in the rest of the these decisions in multiprofes- in relation to therapy and with addition, the Strategic Medicines tee against the pandemic and country. However, even before sional committees was essential regard to the organization of Committee has taken a strong the excellence of the Hospital the emergency gained greater for an agile response and result- its activities. Coping lines were stance to classify as off label all Alemão Oswaldo Cruz in care proportions in Brazil, as soon ed in a rich learning experience created, ranging from the afore- drugs whose action on Covid-19 also benefited the public health as news about the progress of that the Institution intends to mentioned medical protocols was not scientifically proven to network. In addition to its work Sars-CoV-2 in Europe and the take beyond and apply to situa- to the protection of clinical and be effective. at Complexo Hospitalar dos United States began to surface, tions other than the pandemic. care staff and administrative Estivadores and Proadi-SUS, the leaders of the Institution's medi- employees; to communication The leap in the research area Institution participated prom- cal area anticipated the problem with patients and their families. was significant. A total of 41 inently in the development of and contacted foreign peers to articles on Covid-19 were pub- guidelines for diagnosis and start structuring what was pos- Since its origins, all medical lished in highly relevant scien- treatment of Covid-19 by the sible. As for example the segre- procedures at the Hospital have tific journals; something import- Ministry of Health. Through gation of areas and the change been strictly based on scientific ant not only for the reputation Instituto Social Hospital Alemão in service flows within the Hos- protocols, and coping with the of the Hospital and for the Oswaldo Cruz, the Hospital also pital, the establishment of health pandemic is no different. The engagement of the clinical staff, started to manage beds in a rules and protocols and the use Institution's Executive Board but mainly for the contribution campaign hospital in the city of barriers to contain the virus. ignored discussions and politi- in the field of health to advanc- of Santos (see more in Social cal controversies regarding the es in knowledge about Covid-19 Responsibility). treatment of Covid-19, making all (see more in Innovation, Re- decisions supported by scientif- search & Education). 54 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | COPING WITH COVID-19 55

Actions with the > Free parking for all clinical staff and employees; employees > Flexibility of schedules to > Communication with the prevent employees from medical area via the Hospital's taking public transportation website , e-mail marketing, during busy hours; SMS, among other digital and offline channels; > Implementation of a home office policy for relevant > Cancellation and/or reor- activities; ganization of events for the virtual format; > In units dedicated to the care of patients with suspected or Temperature measurement at the > Sending newsletters with confirmed cases of Covid-19, entrance of Paulista Unit recommendations on the restriction to face-to-face use of Personal Protective work for employees over 60 Equipment (PPE) and patient years of age, cardiac patients, management; diabetics, patients with chron- Actions with patients ic respiratory diseases, immu- and family members > Tributes to the frontline nosuppressed patients and teams; pregnant women; > At the entrances to our units, > Provision of information professionals, visitors and totems about new service > Guidance on communication > Creation within the scope of patients are screened with flows and security protocols; and protocols to be adopted the Integral Health Program of temperature measurements; in eventual cases of compan- a space for medical, psycho- > Installation of temperature ions with Covid-19; logical, nutritional and social > Separation of flows, care and sensors at the entrance of the service, among others, as treatment environments, in units, with guidance on how > Acceleration of the hiring direct support to employees addition to operating rooms to proceed in case of signs process of technicians and and their families. for patients not affected by and symptoms of Covid-19; nurses, which was already coronavirus; underway before the pan- > Reinforcement of demic due to the expansion > Communication via website, communication actions on of Vergueiro Unit; social media, SMS, among correct hand hygiene and other digital and offline surface cleaning; > Dissemination of information channels; content, guidelines, protocols > Structuring of a section and updates via intranet to > Creation of a podcast with on the institutional website employees; special episodes about the on the need for continued new coronavirus; health care.

> Signaling changes over an area of over 135,000 m2, We restructured our service flows considering the three units, in addition to the Center and strengthened communication with all for Innovation and Health Education, the Technical users of our units School and the Faculty; 56 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | COPING WITH COVID-19 57

Changes in customer service

We went through several changes to make the Hospital an even safer environment, such as the Availability of ICU beds for pa- Bed occupancy rate at the adoption of new protocols, read- tients with Covid-19 Covid-19 Inpatient Unit justment of flows and spaces for (Paulista and Vergueiro) patient care. We also relocated At the beginning of the some teams, thus ensuring jobs pandemic, the Paulista and March 87.4% and better patient care. Vergueiro Units provided 22 ICU ICU Covid-19 care team beds for patients with Covid-19. April 36.8% Tower E of Paulista Unit, for ex- As the pandemic progressed, May 44.3% ample, now houses only surgical this availability of beds had procedures unrelated to the to be constantly revised to June 56.6% Multiplataform communication disease; and the flow of care in guarantee quality and safe care, the Emergency Department has reaching 74 beds at the height July 55.7% Adding the hospitalizations of In order to expand communi- related to Covid-19 in order to also been changed to provide of the first wave. In addition, it those with the new coronavirus cation with stakeholders the assist the population in fighting a safer environment for both was necessary to act quickly to August 95.6 % to those hospitalized for other Hospital implemented differ- the pandemic. patients and frontline employ- support the care of other chronic reasons the average occupancy ent approaches, channels and September 92.8% ees. Furthermore, the Hospital diseases, whose treatments of the Inpatient and ICU Units formats; taking the right mes- revisited together with its med- were repressed due to the October 95.4% of Paulista and Vergueiro Units sage to each one and making ical staff, teams of the Emer- apprehension of the population in 2020 was 69%. The Hospital everyone aware of the recom- gency Department and the SAC in seeking medical and hospital November 99.0% had a total of 21,897 visits and mended measures and available (Customer Service), the initial care. To meet this demand, 1,975 hospitalizations of patients scientific evidence - always with flow of patient care for those in the Hospital had an average December 100% with Covid-19. a reliable content, endorsed For more information: search of a bed in the Institution. increase of 11% in the care taking by those on the front lines of Facing the new Coronavirus https://www.hospitaloswaldocruz.org.br/ Thanks to a series of adjust- workforce. Regarding the profile the fight against the pandemic. enfrentando-o-coronavirus-covid-19 ments, it was possible to make of patients with Covid-19 who ICU Covid-1 The units were equipped with beds available to everyone even arrived at the ICU, up to 76% bed occupancy rate communications in key places, in the most critical moments of of them required mechanical (Paulista and Vergueiro Units) containing relevant informa- The page has videos, podcast the pandemic in 2020. ventilation, against an average of tion on subjects such as the episodes, educational guides,

26% before the pandemic. This March 81.2% new guidelines on circulation, information and guidance, In order to provide more safety context demanded resilience and mask and distance measures for questions and answers, as well to patients, the Hospital trans- a sense of responsibility on the April 61.9% example. In addition, patients as a chatbot and a dedicated ferred the entire check-up service part of the care taking teams to were impacted by informa- area to answer questions from May 69.3% from the Paulista Unit to Campo guarantee a service aligned with tion displayed in info-graphics Internet users. Belo Unit, which was transformed the Care Model. addressing various aspects of June 85.2% into a Covid-free point at the the virus, the symptoms caused Hospital - that is, without pa- July 84.2% by Covid-19 and the treatment. tients with the disease. Another The campaign 'Hospital Seguro' fundamental action in this regard August 63.9% (Safe Hospital) is also worth was to reinforce the quality of mentioning, as it informed pa- September 80.4% hygiene both in general environ- tients of all the changes made ments and in the places most fre- October 76% in the hospital's service flows. quently touched - such as door November 83.2% handles, elevator buttons and Safe Hospital Campaign The institutional website also other surfaces, for example. https://www.hospitaloswaldocruz.org.br/ gained an exclusive are to December 82.6% hospital-seguro/ disseminate various contents 58 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | COPING WITH COVID-19 59

VIDEOS DIALOGUE WITH THE PRESS AND SOCIETY In addition to the Institution's website , the playlist of the During 2020, communication Hospital was taking with the Hospital Alemão Oswaldo played a fundamental role in safety and health of everyone on Cruz on YouTube and IGTV on establishing dialogue not only its premises. Instagram have been helping with patients, clinical staff and to boost videos that address, employees; but also with the With an eye on the spread of among other topics, clari- press and society as a whole. As fake news the Hospital took on fication on the need or not Hospital Alemão Oswaldo Cruz is the mission before its stake- for testing and guidelines for a reference in health care in the holders to the disseminate ac- Entrance to the employees' cafeteria at special care. Daily posts about country, the organization faced curate and qualified information Paulista Unit Covid-19 were also disseminat- many challenges and had the for a more assertive confronta- ed through social media, which opportunity not only to have an tion of the pandemic. The Insti- today have more than 1.5 million impact on the qualified discus- tution suggested several guide- followers. Today, the Hospital is sion of Covid-19, its symptoms lines to the press and made the largest interlocutor in the and coping strategies, but also to spokespersons available to help Taking care of our team segment's social media. reinforce its positioning and sup- clarify issues about the disease port the fight against fake news. to the population. As example it To ensure the health and care Acknowledging the institution's addressed topics such as ways of employees several measures professionals and their dedica- The first phase of communica- to avoid contagion, advances were taken aimed at disease tion was also one of the prior- tion actions took place shortly in research, use of technolo- prevention and control from ities in communication during after the announcement by gy to support the diagnosis training for the correct use of the year 2020. Examples of this the World Health Organiza- of Covid-19, development of PPE and the management of are videos of tribute to all pro- tion (WHO) that the world was equipment to replace mechan- patients to the adjustment of FULLY HIRED EMPLOYEES AFFECTED fessionals, partners and suppli- facing a pandemic. The Hospital ical ventilation and the history collective spaces, such as the BY COVID-19 IN 2020 ers of the Hospital, in addition then began to focus its commu- of past pandemics. Finally, the auditorium, gym and cafeteria, to a special video dedicated to nication on clarifying Covid-19, Hospital Alemão Oswaldo Cruz which had capacity reduced Physicians All Month Prof. Medical Doctor Angelita its symptoms and risk factors, also prepared a series of digi- and environments redesigned. Employees employees Habr-Gama, who recovered providing guidance on personal tal educational files on how to The purpose was to promote March 2020 3 65 from Covid-19 after 54 days of care to prevent contagion and prevent the disease and created social distance and more safety April 2020 5 129 hospitalization. providing guidance to physi- a podcast with special episodes to the teams. Furthermore, a cians and employees regarding about the new coronavirus. mental health support program May 2020. 1 118 health protocols. After a few was developed with teleconsul- June 2020 1 113 months of the pandemic in Bra- tation and other channels. zil the second phase of the Insti- July 2020 3 111 tution's communication actions The estimated prevalence of August 2020 1 54 sought to encourage health care people infected by Covid-19 Video of tribute to health September 2020 1 23 professionals habits and encourage patients during 2020 was 23%, taking to continue their treatments, into account all employees. The October 2020 0 30 exams and routine visits - also Check out the Podcast of Hospital Alemão professional categories with November 2020 2 68 reinforcing the care that the Oswaldo Cruz on Spotify greater contamination were December 2020 3 84 those of nurses, nursing technicians and hygiene professionals. Grand Total 20 795 No physician in the active clini-

Video of tribute to Prof. Medical cal staff fully hired by the Hospi- Doctor Angelita Habr-Gama tal died as a result of Covid-19. 60 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | COPING WITH COVID-19 61

TELECONSULTATION

The need to deploy a telemed- Initial Online Health Assessment, tool. And on May 15 the second icine tool had already been the system could offer three delivery of this tool was made discussed at the Hospital. With possible outcomes according to with a number of improve- the pandemic the topic gained each case: stay at home (the ini- ments. utmost urgency so that the tial assessment did not refer to a clinical staff could keep up with respiratory problem or Covid-19 The said tool aimed at Covid-19 patients, especially those with positive case), schedule a virtual and made in partnership with chronic diseases. visit (the Initial Assessment Conexa was kept for some time

Automatic temperature and signaled the need for medical and then turned off as the Hos- humidity alert system for med- Also in March, the Hospital part- assessment) or go to the Emer- pital platform was established as icines and vaccines nered with Conexa - a startup gency Department when the the Institution's virtual gateway. in the field of telemedicine - to Initial Assessment referred to a quickly make available a smaller respiratory problem or symp- In July, the Virtual Emergency and more urgent product where toms of Covid -19. Service project was imple- patients could answer questions mented for the remote care of The central role of technology about the new coronavirus.Open On April 30, the Hospital patients who are maintaining to the general public this service launched the initial version (and social distance or who may be Having the Innovative Tradition PEP-Online, a medical record acquisition of new equipment was a web interface in which, still restricted to some special- in other cities. This teleconsul- as one of its values, Hospital management tool integrated and in the adaptation of its given people's responses to an ties) of its own telemedicine tation is an option for patients Alemão Oswaldo Cruz already with Tasy, a hospital manage- number of VPN (Virtual Private provided tools for online access ment system, made available Network) licenses in order to to test results and the clinical through the Medical Portal and make the remote connection history of patients. With the 'Meu Oswaldo Cruz' applica- with the Institution feasible and pandemic and the needs that tion, provided the clinical staff allow employees from the ad- emerged from it, especially with easier and more dynamic ministrative sectors, which were those related to remote access access to the entire clinical largely placed in remote work, to the Institution's services, digi- history and evolution of each to carry out their daily activities tal channels such as portals and patient in a single tool - which regularly. Between the end of applications had an increase in even guaranteed more security 2020 and the beginning of 2021, access of 30%. Faced with this for the procedures performed 120 to 140 employees were still new reality and committed to inside the Hospital. working remotely. becoming an increasingly digital health institution, the Hospital It was also necessary to support invested in 2020 around R$ 4 the large number of employees million in the hiring of new tech- placed in remote work. To this nologies, information technol- end the Hospital invested in the ogy and equipment consulting services, including optimizations to the Brazilian General Data Protection Act (LGPD) and op- R$ 4 million was invested by the timizations of existing solutions. Institution in new technologies The amount is 200% higher than invested in 2019. and equipment Vergueiro Unit ICU 62 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | COPING WITH COVID-19 63

LEARNINGS & NEW BUSINESS

Driven by the demands aris- > Telecheck-up - treats the ing from the pandemic Hos- patient through virtual consul- pital Alemão Oswaldo Cruz tation with a single physician, launched a series of products general practitioner. This phy- Drive-Thru for testing Covid-19 in addition to the telemedicine sician will carry out analysis, at Paulista Unit tool. The following are the main request for exams, evaluate highlights: results and when necessary appoint other specialists to > Drive-Thru for Covid-19 complete the treatment. This who have simpler symptoms indications for physical and/or patients from other cities and Testing - in partnership modality means more simplic- and/or complaints, whether or respiratory rehabilitation; and te- even from other Brazilian states with the Fleury Laboratory. ity, agility and lower cost to not related to COVID-19. Upon leorientation, used for follow-up to consultations with special- 100% virtual Scheduling, patient care, the patient. accessing the platform on consultations with patients al- ists from the Hospital and the emergency collection and availability of our website the patient goes ready assisted and for obtaining use of electronic prescriptions results on the Patient Portal > Partnership with airlines for through a screening to iden- second medical opinions. - made possible by a function- department is carried out by the Institu- Covid-19 testing in Octo- tify possible signs of severity ality on the platform that allows tion and the analysis of the ber 2020 and January 2021, and can be informed about the The advances in telemedicine digital signatures of documents. guarantees safety material by Fleury; respectively. The Hospital need for an assessment in per- were also driven by the activi- established a partnership with son. Since December patients ties of the Hospital with Proa- and convenience in > HAOC at Home - where pa- Lufthansa and Air Canada who are taken care of in person di-SUS. After all, the dialogue tients have the option to be to conduct tests to detect at Paulista and Vergueiro Units between the institution's clini- accessing urgent assisted at home and carry Covid-19. |||UNTRANSLATED_ (except outpatient clinics) have cal staff and physicians work- and emergency out some cardiological exams, CONTENT_START|||Os pas- the possibility to schedule a ing in the public health system such as HOLTER and MAPA; sageiros das companhias têm return visit through the Virtual across the country - which services desconto na coleta do exame Emergency Service. This mea- already demanded better com- PCR (nasofaringe e orofar- sure aims to reduce the circu- munication structure - became inge), que pode ser feito por lation of people at this time of even more intense and frequent meio do serviço de drive-thru the pandemic, reaffirming the during the pandemic. na Unidade Paulista. |||UN- Institution's commitment to TRANSLATED_CONTENT_ patient safety. Some of the benefits from using END|||Lufthansa offered the telemedicine during the pan- participants of its Member- A session was also implement- demic are expected to remain ship Program (Partner Plus ed in the telemedicine tool to some degree even after the Benefit) the collection of PCR for telerehabilitation, that is, end of the health emergency. through the drive-thru as an for monitoring patients in the Among them are the access of option to redeem points. 64 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | High Performance 65

IN THIS CHAPTER > Quality, safety and clinical outcomes > Business results High Performance OPERATIONAL EXCELLENCE, HIGH QUALITY AND SAFETY PARAMETERS AND INCREASING RESEARCH AND INNOVATION EFFORTS ARE THE PILLARS FOR THE HIGH PERFORMANCE OF HOSPITAL ALEMÃO OSWALDO CRUZ 4. 66 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | High Performance 67

The motto immer besser (“better Policy on Quality, Patient Safety result, the operating units of and knowledge-dissemination the virtual environment, enabling CLINICAL OUTCOME PROGRAM and better”) shows that doing and Clinical Outcomes and a Hospital Alemão Oswaldo Cruz actions. The traditional scien- continuous security practices that more and better is a philosophy Quality and Safety Improve- in São Paulo are all certified by tific event Journey of Quality are so important for the mainte- Since 2016, the Institution has that does not exist by itself: it ment Program to establish the JCI. and Safety of Hospital Alemão nance of the Safety Culture maintained the Clinical Outcome is always at the service of the guidelines and processes that Oswaldo Cruz was held virtually Program aimed at the study of patient. identify and prioritize areas and Another important highlight and addressed the topic of the In a year focused on facing delivering value to the patient. critical points. All materials and was the beginning of the prepa- impacts of digital transforma- Covid-19 many efforts and The program started aiming at Delivering the best diagnosis, supplies used in the Hospital ration of the team of Complexo tion in improving quality and actions were aimed at ensuring results for bariatric surgery and offering the best treatments undergo a quality and safety Hospitalar dos Estivadores for safety of patient care. There the safety of processes relat- in 2017 the Hospital became part and pursuing the best possible evaluation process. In addition, the accreditation process by was also the first edition of the ed to the care of patients with of the Brazilian Association of clinical outcome are the Hospi- the Hospital has processes the JCI. Training and internal Improvement and Innovation Covid-19 and the protection of Private Hospitals (Anahp) group, tal's premises not only from the in place to ensure the man- audits were carried out to diag- Contest, which resulted in an employees. For this purpose which in partnership with the medical-assistance point of view, agement of non-clinical risks, nose the practices and struc- institutional mobilization in specific protocols were devel- International Consortium for but also in its strategy and in the expressed by assessing the ture of this Hospital, setting up search of new solutions and oped to address this pathology, Health Outcomes Measurement day-to-day operational decisions. quality of supplies and materi- working groups to prepare the innovative processes to make segregate flows and training (ICHOM) and in a joint effort als, managing resources such Institution for this journey. patient care safer. aimed at protecting employees of eight hospital centers was a as water, energy, gases, besides and patients. pioneer in collective implemen- safety in dealing with waste and The commitment to patient In the same virtual format the tation of standardized measures complying with the Brazilian safety progresses in all med- Safety and Employee Week was The diligence in adapting and of clinical outcomes. General Data Protection Act ical and healthcare areas, in held addressing security content suiting care resulted in a recov- (LGPD) principles for informa- addition to the support teams in various dimensions, through ery rate of 88% of inpatients In 2020, the Clinical Outcomes tion security. Audits are regular- themselves. A Strategic Quality videos of interviews with expert diagnosed with Covid-19. Program followed 5,142 patients ly performed by the responsible and Patient Safety Committee guests, with the participation of discharged from treatments and Quality, areas and communication with was created composed by the the Executive Board and quiz for In 2020, there was no fine, pen- procedures for bariatric surgery, employees and the medical Quality and Patient Safety team, employee interaction. Likewise, alty or warning applied to the heart failure, breast cancer, hip safety and staff is ensure through a chan- the medical and healthcare the Rounds and the Security Institution for health and safety arthroplasty and bone marrow nel to report occurrences and corporate managers, as well Committee have been adapted to issues. transplantation. clinical out- risk situations. as the medical and healthcare executive directors. The purpose In addition to these cases, the comes The main highlight of the year of the committee is to speed up program also monitored patients 2020 in terms of audit policies and expand actions of quality who resorted to the service GRI 102-11; GRI 103-2, 103-3 | 416, 416-1; and processes was when the and patient safety. due to the new coronavirus to GRI 103-2, 103-3 | 417 Emergency Department, the assess their quality of life. Out Being among the best hospitals outpatient chemotherapy Risk management is one of the of followed up patients until 90 not only in Brazil but also in the service of Vergueiro Unit main actions to ensure safety. days after infection by Covid-19, world regarding practices and and the Vaccination Center This is done through risk an- ICU discharges reported an results of Quality, Patient Safety of Campo Belo Uni received alyzes carried out proactively average of 72.5 points on the and Clinical Outcomes is key in the certification of the Joint in all aspects that may impact visual analog scale from 0 to 100 the strategy of Hospital Alemão Commission International (JCI), patient care. In 2020, special of how good or bad their health Oswaldo Cruz. Success in this the same awarded in 2009 to attention was given to non-clin- was, while those discharged area depends on daily efforts the Paulista Unit. The last one ical processes with emphasis on from the Inpatient Unit reported based on a series of interna- was awarded in 2018 with a rate the risks related to the interface the average of 78.2 points on the tionally recognized standards of adherence to the standards between Information Technolo- same scale. The main impacts that unfold in processes, proto- of 99.7%. As in the hospital gy and Infrastructure and their on health reported by patients cols and indicators. complex, the Vergueiro and impact on patient safety. referred to the sequelae - with Campo Belo Units presented greater or lesser severity - To ensure good quality man- their management and quality Adapting to the conditions of arising from the disease itself. agement and patient safety, processes and their main social distance and isolation did the Hospital has an Institutional indicators and projects. As a not prevent awareness-raising Reception of Tower E - Paulista Unit 68 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | High Performance 69

Rate of opportunities and PERFORMANCE ON reorientation in the administration Stroke Lethality INDICATORS AND RATES of high-alter medication

EXCELLENCE IN OUTCOMES Incidence density of 34.4% 9.2% bloodstream infection related RELATED TO COVID-19 27.7% 3.1% to central venous catheter ICU Reference - Stroke 30.51% 11% Mortality - ANAHP Epimed Monitor data - software used in - Paulista and Vergueiro Units Hospitals: 5.6% the Brazilian ICUs project and that was (x/1,000 catheters-day) developed by the Brazilian Intensive Care Association (AMIB) in partnership with 0.48 Injury Falls Epimed Solutions -, collected from a set of 402 hospitals and about 500 ICU beds 1.23 0.52% show that patients of Covid-19 assist- 1.27 Reference - Anahp Observa- ed by Hospital Alemão Oswaldo Cruz tory: 1.96 0.39% Reference throughout 2020 were from a higher age group and presented greater severity 0.36% than the average of Brazilian hospitals. 2018 2019 2020 However, it was the health institution that Density of drug-related adverse performed the best in the whole country events in terms of lethality. In other words: even in comparison with the Brazilian ICUs 0.37 with better performance, the processes, BLOODSTREAM INFECTION moted continuing education and result in AMI and stroke. In order resources and teams of the Hospital man- 0.30 incorporated new technologies to reduce this type of damage aged to take the lead and proved their In 2020 there was an increase in in order to minimize the occur- to the health of patients the value proposal. 0.35 cases of bloodstream infections rence of infections in intensive Hospital has taken the utmost in intensive care units. This indi- care units. effort to ensure safe care for all, cator reflects the greater sever- so that patients can continue the ity and vulnerability of patients treatment of chronic diseases. Percentage of adherence to this type of event. Internation- STROKE The protocols for Covid-19 are to risk assessment of venous al publications in the area of pre- constantly updated providing for thromboembolism vention of healthcare-related in- The increase in the rate of the monitoring of the risk of car- fections have shown an increase strokes during 2020 was not an diovascular events in this group in infection rates in ICUs dedicat- isolated phenomenon at Hos- with a preventive and therapeu- 88.7% ed to the treatment of Covid-19. pital Alemão Oswaldo Cruz. tic approach. To alert the popu- 87.5% The characteristics of pathogens Brazilian medical associations lation at greatest risk the Hospi- causing these infections have and medical-scientific publica- tal promoted educational actions 97.7% also changed. According to the tions have identified an increase through its digital media. Health Surveillance Coordination in acute cardiovascular disease (COVISA) of the city of São Pau- events, such as acute myocar- Sepsis Lethality lo, this difference in the set of dial infarction (AMI) and stroke hospitals in the city is indepen- during the Covid-19 pandemic. dent from the group of hospitals Possibly, the late search for hos- 8.1% (public, private, philanthropic or pital medical care contributed 7.8% educational). At Hospital Alemão to this type of complication. In Reference - Latin Oswaldo Cruz cases of blood- addition, Covid-19 is a disease 17.3% American Sepsis Institute (ILAS): 22.3% stream infections were moni- that causes extrapulmonary tored in real time. In addition, the manifestations and leads to the Institution adapted routines, pro- formation of blood clots that 70 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | High Performance 71

DIRECT ECONOMIC VALUE CREATED (R$ THOUSAND) GRI 201-1

2018 2019 2020

Revenues 818,527 902,857 891,676 Business results GRI 103-2, 103-3 | 201

As expected, the character of This trend significantly affected ended the year with slightly ECONOMIC VALUE DISTRIBUTED (R$ THOUSAND) GRI 201-1 an absolute exception of 2020 the Institution's revenues and higher revenue than in 2019 - was imposed on all the plans bed turnover throughout the although below the planned for 2018 2019 2020 and forecasts of the Hospital. first semester. Another import- the year. Employee salaries and benefits 353,422 381,247 405,602 In connection with its strategy ant impact on strategic indica- the Institution has a growth tors - such as the participation However, some trends con- Other operating expenses 372,607 360,504 394,587 projection based on its areas of of areas of emphasis on the tributed to the control of the Proadi-SUS funds invested 50,618 75,619 66,646 emphasis and the greater offer revenue - was the change in impacts of the pandemic on Financial revenue/expense 5,865 22,471 28,330 of outpatient, care and surgical the profile and mixed revenue the business. From the financial services in the units in operation. in 2020 due to hospitalizations stand point the Hospital estab- Total 782,512 839,841 895,164 The pandemic, however, caused and the Intensive Care Unit lished successful partnerships a significant drop in elective (ICU) in face of the worsening with the City of São Paulo for GRI 201-1 procedures and care services. of Covid- 19. hiring ICU beds in the Ver- WITHHELD ECONOMIC VALUE (R$ THOUSAND) gueiro Unit and with a private Withheld 2018 2019 2020 Despite the difficulties the This exceptional situation health operator that has its Institution ended the year with affected most strongly Vergue- own service network. In addi- “Direct economic value generated” 36,014.58 63,016.25 - 3,488.62 a slight increase in its revenue - iro Unit, which was still in the tion, the Hospital carried out a less “Economic value distributed" which remained at R$ 852.497 ramp-up process and depends series of measures to face the million, with a 45% share of the to a considerable extent on challenging situation imposed areas with emphasis on reve- elective services based on by the pandemic, such as the ECONOMIC VALUE DISTRIBUTED (%) GRI 201-1 nue, and registered an EBITDA packages. However, even with contracting of a R$ 90 million of R$ 47.4 million. the pandemic, Vergueiro Unit credit line made up of three 2018 2019 2020

Employee salaries and benefits 45.17 45.40 45.31 The Institution's preparation to deal with the pandemic in- Other operating expenses 47.62 42.93 44.08 volved the Emergency Depart- Proadi-SUS funds invested 6.47 9.00 7.45 ment - which had a significant Financial expenses 0.75 2.68 3.16 raise in patient admission in the first weeks of the pandemic and RECOGNITION AND Total 100.00 100.00 100.00 later registered an abrupt fall DISTRIBUTION OF VALUE that only reversed in the middle of June. Another area partic- The employees of Hospital Alemão ularly affected was oncology: Oswaldo Cruz received an extraordinary reductions in diagnoses and bonus on account of their outstanding R$ 30 million financing lines, Careful financial management in patient visits contrasted with commitment throughout 2020. In addition, the efforts to have an advance the midst of the crisis proved to relative stability in the chemo- the Institution did not make cuts in salaries payment from healthcare op- be decisive for the Hospital to therapy services of the special- or personnel in the period. The actions of erators, the extension from 90 end the year in a comfortable ized center. This was closely re- valuing the teams in the midst of a period to 120 days of payment term situation, with R$ 102 million in lated to the concern of patients of great difficulties for the entire sector to long-term partner suppliers cash - that is, a larger amount actually leaving their homes resulted in increased engagement and in (mainly in the area of cancer than the loan taken out by se- and going to the Hospital. the feeling of belonging on the part products) and several renegoti- curity to guarantee cash flow to of the employees. ation of contracts. the Institution. 72 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | High Performance 73

Indicators panel Average occupancy - hospitalization Emergency Cardiology surgeries - Paulista OUR OPERATIONAL PERFORMANCE Care Visits - Vergueiro Unit* and Vergueiro Units 82.2% (Paulista) IN NUMBERS 17.9% (Vergueiro) 551 78.1% (Paulista) Reference 38.9% (Vergueiro) 4.454 574 *Emergency Department opened in 68.9% (Paulista) 17,804 374 2018 2019 2020 30.7% (Vergueiro) August 2019

ICU occupancy rate Outpatient care Check-ups - Neurological surgeries - Paulista - Paulista Unit - Paulista Unit Campo Belo Unit and Vergueiro Units

76.9% 33,875 1,328 519

69.9% 34,061 1,229 589

71.5% 37,161 1,619 596

ICU occupancy rate Outpatient care Check-ups - Orthopedic surgeries - - Vergueiro Unit - Vergueiro Unit Paulista Unit Paulista and Vergueiro Units

11.2% 19,447 3,028 2,884

21.9% 31,718 3,091 3,076

54% 39,908 577 2,852

ICU care Outpatient care Hospitalizations - Paulista Robotic surgeries - - Paulista Unit - Campo Belo Unit and Vergueiro Units Paulista Unit

2,934 2,066 24,613 250

2,955 1,766 26543 336

1,909 1,220 26,538 235

ICU care Emergency Care visits Total Surgeries (Operated Total Surgeries (Operated - Vergueiro Unit - Paulista Unit Patients) - Paulista Unit Patients) - Vergueiro Unit)

156 86,922 16207 2247

346 86,250 15626 4595

813 61,705 12474 6929 74 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 75

IN THIS CHAPTER > Patient journey > Employees > Staff development > Suppliers Care in relationships

THE PASSION FOR CARE IS PART OF THE INSTITUTION'S HISTORY AND TRANSLATES INTO ACTIONS AIMED AT WELCOMING AND RESPECTING OUR PATIENTS, DOCTORS, EMPLOYEES AND PARTNERS 5. 76 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 77

The assistance teams' THE OSWALDO CRUZ CARE MODEL® service followed the Hospital's Care Model

Person al an alth d P The quality of service and care The Care Model Group (GMA), A great adaptive process was He D ro ogy evel fes nol op si is a competitive advantage of now called the Corporate Core carried out by assistance lead- ch me on Te nt al Hospital Alemão Oswaldo Cruz, of Practices and Care Model, ers from all areas - outpatient I d n built over decades and cultivat- promotes and monitors the cor- clinics, emergency services, ICUs e te s C r a C a d b l i ed daily by its employees. rect application of the premises - of the Paulista, Vergueiro and - e lii p s e c n n p c c i r i t o ali i o p of this model in all units that Campo Belo Campus to coordi- n c i uality i i c a l e a t Q i r t a c n d a Through Oswaldo Cruz Care compose the Hospital. nate the coping with the global i P a h v ll r on for y E v i c s a Model® (Modelo Assisten- health crisis without losing the as re tt o P ee cial Hospital Alemão Oswaldo In 2020, shortly before the characteristic features of the nn aa

m nn PATIENT AND FAMILY m Cruz®), the Institution promotes outbreak of the Covid-19 culture of assistance and care, II

a set of guidelines and premises pandemic, the book “What I which are differentials of the n i

l e i

in the relationship with patients learned by taking care of you” Institution in the health market. e a n

r t o

a n

i and their families combining the was launched. This collabora- C u

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n c passion for care, with humaniza- tive production, coordinated One of the measures adopted to E c tion and focus on the patient -in by the Chief Office of Patient minimize the suffering and an- A

their journey and their needs- as Care, shares the experiences of guish of family members was the S y afety d e s requirements to make decisions professionals of the institution's authorization of visits to Covid-19 E a d b fo u C - and guide efforts. assistance team. patients admitted to the ICU, r c C n ip s a o on h e ti mpassio s lf on pas n re following a program with specif- - tio a ca la c re Re Oswaldo Cruz Care Model has ic safety protocols. Internally, a In dividualized and as its basic premises the con- board of emotions was created integrated care cepts of relationship based care so that assistance employees (RBC) and primary nursing (a could externalize their feelings key concept in care). on the moment of crisis. adopted by the Brazilian Asso- ciation for Patient Quality and Efforts in the Pharmacy area Safety. The active participation and its interface with Supplies of healthcare in efforts linked were also of vital importance, to the Covid-19 Brazil Coalition with actions aimed at ensur- was outstanding, specially on ing that critical supplies were clinical drug trials. available to guarantee safe care for patients. One of these initiatives was the implementation of a tool to anticipate the demand for medicines, later

Pet visits to inpatients were maintained following all safety protocols. 78 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 79

others, with the virtual control of access to buildings bacterial and viral filter in the assistant Wal as the contact by QR Code linked to digital circuit of non-invasive fans. point. With the acquisition transformation initiatives; Thus, it is possible to carry out of Salesforce tools in 2020, therapy without the genera- the Hospital began to boost During the year, specific mea- tion of aerosols; these engagement actions; sures were also implemented to assess the care for patients > Quarantine Self-Care Manual > Redesign of the "Meu Os- in recovery from Covid-19. The . Developed by the Team of waldo Cruz" app. In 2020 most significant were: Best Practices in Integrative the application, that already and Complementary Therapies had tools for exam results > Adapter for non-invasive in Health, the small manual and health data sharing, was mechanical ventilation, contains suggestions and tips updated for better usability developed by the Hospital's on nutrition, yoga, foot-bath with a new layout. Through- physiotherapy area in part- and mindfulness that aim to Patient Experience out 2021, new features will be nership with the Center for reduce stress and bring emo- added, such as scheduling Innovation and Health Edu- tional and spiritual balance The Institution has sought to such as the pandemic's – when appointments and exams, cation and external organiza- during the days at home; mature its patients' journey the fear of visiting hospital units check-in and check-out. In tions. Created to allow the use through continuous investment has led many people to put addition, physicians were able of non-invasive mechanical > Cardiopulmonary telereha- in the promotion of the Care in-person appointments on hold, to use Electronic Patient Re- ventilation devices (so-called bilitation, a service made Model and in offering conve- thus calling for solutions with cords for online consultations, BiPAPs) in patients with possible by telemedicine and nience, security and humanity the use of technology. a function already available Covid-19 admitted to the ICU, that allows patients who had in the channels and instru- on the website in 2020; this innovation eliminates the been undergoing cardiopul- ments that accompany the In 2020, all the patient's digital contraindication originally monary rehabilitation at the patient and the family member contact points were mapped > Other Services launched in linked to these devices (due to Hospital's outpatient clinic in the Hospital. with the Hospital, through 2020 that will be implemented the possibility of contamina- to continue their therapy at interviews with patients and in 2021 are: Self-Service for tion by the healthcare team) home during the pandemic Governance on this issue doctors to identify opportuni- ease and agility in creating through a new device that – and with the same team of includes the Chief Office of Pa- ties for improvement. These are assistance records and also the allows the adaptation of a physiotherapists. tient Care and the Patient and some of the most important The pandemic Family Advisory Committee, measures taken: created in 2018 and which, in accelerated efforts 2020, had 13 members and held > The creation of the virtual three meetings. assistant Wal, whose person- The Hospital created a room dedicated to the motor to improve patients' ality and name were chosen and pulmonary rehabilitation of patients diagnosed All the questions of those in a poll with the employees with Covid-19 admitted to the Vergueiro Campus. On digital journey who pass by or remain in the of the Hospital. It is already site, the physiotherapy team performs customized Hospital are duly registered, active as a chatbot for vir- activities with the aim of rehabilitating the patients' analyzed and converted into tual service at the official motor and respiratory capacities. The exercises are response action. website or WhatsApp. More programmed individually and respect the limitations patient engagement actions of each patient. In this way, patients gain more The pandemic has substantially are to be implemented in autonomy and feel safer to resume activities after accelerated efforts towards the 2021 through digital chan- leaving the Hospital. digital journey, a key point in the nels, such as confirmation of patient's experience at times appointments, exams, check- up and campaigns, among 80 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 81

Hospital Alemão Oswaldo Cruz VOLUNTEER WORK periodically conducts satisfaction surveys based on the Net 2020 was the starting point Promoter Score (NPS) method. for the Volunteer Program at Respondents assess the Institu- Hospital Alemão Oswaldo Cruz. tion and its services with scores Launched shortly before the Paulista Campus ICU from 0 to 10. The consolidated outbreak of the pandemic, it result of the indicator in 2020 was resumed with the stabiliza- was 76.7% – above the 73% of tion of cases and relies on the 2019. The target set for 2020 presence of volunteers within Our team 103-2, 103-3 | 401 was 80%. GRI 102-43, 102-44 the Institution's health and safety protocols. Today there are 16 The pandemic Recruiting the best profes- (GPTW) survey, which annually We also have specific satisfac- volunteers performing activi- sionals who stay committed to ranks the best companies to tion surveys for each type of ties to welcome patients and made it necessary the Institution's purpose and work for in Brazil, conducting journey and we hold periodic families. The goal is to increase business model is a priority in surveys with central information meetings with the different both the number of volunteers to create quick Strategic Planning, which relies that directly impact the organi- areas of the Hospital to create and the number of activities on human development as one zational environment and corpo- action plans in relation to any performed by the group at the training sessions of its pillars. rate results, demonstrating how reported problems. The Institu- Paulista Campus, as well as tak- carried out with leadership is exercised at the tion recently changed its NPS ing the initiative to the Vergue- The Institution faces the chal- Institution, as well as the level research platform, in order to iro Campus. employees already lenge of reaching staff, espe- of motivation and engagement carry out customized shots by cially the most qualified staff of employees in relation to the sectors and to have tools for at their jobs, in order acting in healthcare area, in its objectives of the Hospital. the construction of manage- working locations; the Covid-19 ment information panels. to guarantee the pandemic made this scenario A total of 472 out of 1,000 in- care of all patients more complex, with the need vited employees (that is a 47% for rapid training at the work- participation rate) answered the in the most critical place to ensure the care of all GPTW survey, obtaining a 73% patients at critical moments. favorable response and earning moments. the certification. The People & Management area has relevant programs that To strengthen the management aim to strengthen the culture of the workplace environment, and improve the organizational there were implemented com- environment, develop and re- mittees with the participation of tain the best professionals and employees and managers and help them stay in line with the Chief Officers acting as spon- long-term plan, in addition to sors. The structure resulted in a dealing with risks and business plan with actions that are being opportunities. implemented. Integration of the Volunteer Program In 2020, this department re- peated the Great Place to Work 82 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 83

In 2020 the Hospital launched a new Recruitment and Selection policy to further promote the internal use of employees, promoting the appreciation and career growth at the Institution

and contributing to organiza- novation, Research and Educa- workplace environment survey tional objectives. In addition, tion. Corporate Education has results – in addition to strategic the Hospital offers an incentive the support of specialists from demands from the Executive benefit for the development different areas of the Institution Board. All training actions are of the employee, the PDI Up, for the development of techni- based on a strategic report, which aims to provide educa- cal and behavioral training. which includes the program tional support to achieve the and the planning, execution and goals established in the em- The main guidelines for the de- evaluation of the initiatives. ployee's Individual Develop- velopment of training are: defi- ment Plan (PDI). The PDI Up nition of training needs (takes can be requested for technical place once a year with the training, undergraduate and objective of planning the train- graduate courses, in addition to ing courses for the following extension and training courses year and whenever necessary), and participation in conferences annual analysis of the results and scientific events. of employees' performance evaluations, analysis of the The objective is to help people RECRUITMENT AND SELECTION positions, expanding the team's The main internal policy cover- develop a focus on well-being, selection capacity and pro- ing training and education at training and technical improve- In a challenging pandemic year, ductivity. In September 2020, the Institution is the Develop- ment, fostering leadership for the Institution had to review a new Recruitment and Selec- ment and Learning Program, change and a more collabo- and improve recruitment and tion policy was released with which focuses on directing the rative culture. With regard to selection processes and tools, the objective of encouraging Hospital's performance in the initiatives focused on this area in order to attract the best mar- the internal use of employees, development of employees, in 2020, some mandatory train- PERFORMANCE MANAGEMENT ket professionals aligned with promoting the appreciation and ensuring the effectiveness and ing topics are defined annually the strategy. The entire selec- career growth at the Institution. standardization of develop- for the entire Institution. During In 2020, 360° performance assessments tion process started to be 100% ment strategies, from training the year, the topics of Hand were conducted for managers and 180° online, with the implementa- The integration of these em- admissions programs to those Hygiene were discussed; NR 32 performance assessments for other tion of the ATS platform, which ployees is another important of continuous development, – Safety and Health at Work in employees. A total of 2,099 assessments uses artificial intelligence and point. The 100% digital admis- ensuring personal and profes- Health Services; NR 23 – Fire were completed, with feedback . They machine learning to evaluate sion was implemented through sional growth through techni- Prevention and Fighting . are relevant inputs for the development the candidates that match the a specialized platform with cal, scientific and behavioral of employees, who can have feedback positions profile and are more electronic management of all investments. Training management at the from their managers on their potential aligned to the values through documents, ensuring gains in Institution is carried out by the and opportunities for development, the cultural fit test, conduct- operational efficiency and re- Another pillar of investment is Corporate Education team, considering both their current and future ing technical tests and posting duction in the use of materials. the training of leaders in the which operates under the man- functions. video presentations. As a result, technical and behavioral skills agement of Multiprofessional it was possible to significant- DEVELOPMENT & necessary for managing people Education at the Institute of In- ly reduce the time to fill the CAREER GRI 103-2, 103-3 | 404 84 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 85

EMPLOYEES BY TYPE OF EMPLOYMENT CONTRACT AND GENDER GRI 102-8 GRI 401-2 BENEFITS

Contract type 2018 2019 2020 Oswaldo Cruz offers a wide Well-Being Program, Education Temporary third-party employ- Men Women Total Men Women Total Men Women Total range of benefits to employees, grants (only for direct employees have access to the on-site Indefinite term including medical and den- ees, with more than 18 months cafeteria and public transport 915 1,771 2,686 1,035 1,942 2,977 1,153 2,160 3,313 tal assistance, private pen- in the institution), daycare sup- vouchers. Definite sion fund (only for employees port (for employees with chil- 10 34 44 8 26 34 3 3 6 term who choose the benefit), life dren from 0 to 6 years of age), Total 925 1,805 2,730 1,043 1,968 3,011 1,156 2,163 3,319 insurance with disability or meal vouchers, on-site cafeteria temporary disability coverage, and public transport passes. Apprentices and interns were also considered for these benefits. All the company's units are located in the southeastern region

EMPLOYEES BY TYPE OF EMPLOYMENT GRI 102-8

Job Type 2018 2019 2020 AVERAGE MONTHLY HOURS OF EMPLOYEE TRAINING BY GENDER GRI 404-1 Men Women Total Men Women Total Men Women Total 2018 2019 2020 Full time 609 1,146 1,755 660 1,267 1,927 725 1,330 2,055 Men 3.61 3.54 2.96 Part-time 316 659 975 383 701 1,084 431 833 1,264 Women 4.07 3.75 3.17 Total 925 1,805 2,730 1,043 1,968 3,011 1,156 2,163 3,319 Total 3.91 3.68 3.10

EMPLOYEES BY AGE GROUP GRI 102-8

MONTHLY AVERAGE HOURS OF EMPLOYEE TRAINING BY 2018 2019 2020

FUNCTIONAL CATEGORY GRI 404-1 < 30 years 592 645 758

from 30 to 50 1,922 2,061 2,305 2018 2019 2020 > 50 years 216 305 256 Administrative 3.93 3.26 3.02 Total 2,730 3,011 3,319 Care Delivery 4.04 3.77 3.21

Service 1.94 3.83 1.81

Operational 3.38 2.85 3.58 WORKFORCE BY EMPLOYEE CATEGORY GRI 102-8

Leaders 5.66 6.06 2.60 2018 2019 2020

Total 3.91 3.68 3.10 Executive Board 5 8 11 Management 29 33 34 Note: The average training hours shown corresponds to the monthly average. It would total 37.2 hours of training per employee per year (compared to the Brazilian average of 15 hours per year per employee). Head/coordination 87 93 123

Technical/supervisor 25 23 28

Technician 770 795 977

Administrative 519 515 573

Operational 1,233 1,480 1,473

Trainees 18 23 46

Apprentices 36 33 39

Interns 8 8 15 Emotions Panel at the ICU of Paulis- ta Campus Total 2,730 3,011 3,319 86 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 87

MEMBERS OF GOVERNANCE BODIES GRI 102-8

2018 2019 2020

Board of Directors 15 15 13

The members of the Board of Trustees and the Audit Board of the Hospital were considered

HIRED EMPLOYEES BY AGE GROUP GRI 401-1

Employee in the care area being vacci- 2018 2019 2020 nated against Covid-19 No. Rate No. Rate No. Rate

< 30 years 214 0.08 339 0.11 472 0.14 from 30 to 50 151 0.06 396 0.13 648 0.20 CORPORATE HEALTH > 50 years 5 0.00 10 0.00 9 0.00 covered by the services of an Result of the implementation outpatient unit that include con- Total 370 0.14 745 0.25 1,129 0.34 of the strategy in the five-year sultations with the family health period, the hospital's corporate team and prevention and health HIRED EMPLOYEES, BY GENDER GRI 401-1 health program is called the All- promotion actions. round Health Program and takes 2018 2019 2020 care of more than 7 thousand In 2020, absenteeism rates lives, among employees and de- registered a slight increase, un- No. Rate No. Rate No. Rate pendents. The initiative focuses der the impact of the Covid-19 Men 115 0.04 268 0.09 355 0.11 on the dimensions of well-being cases that affected more than Women 255 0.09 477 0.16 774 0.23 – physical, mental, etc. – and 790 employees. explores the segment of primary Total 370 0.14 745 0.25 1,129 0.34 health care with a preventive, coordinated, comprehensive and innovative approach in terms of GENERAL ABSENTEEISM RATE GRI 401-1 EMPLOYEES WHO LEFT THE COMPANY, BY AGE GROUP population management. During the year, there were 2,197 med- Month 2018 2019 2020 2018 2019 2020 ical visits within the program, January 2.11% 2.43% 2.42% No. Rate No. Rate No. Rate mostly through telemedicine. February 2.31% 2.35% 2.63% < 30 years 204 0.07 202 0.07 255 0.08 The successful experience of the March 2.23% 2.65% 4.51% from 30 to 50 296 0.11 278 0.09 475 0.14 All-round Health Program, that April 2.55% 2.36% 4.42% > 50 years 66 0.02 36 0.01 47 0.01 earned the Global Healthy Work- place Award in 2018, created the May 2.54% 2.73% 3.91% Total 566 0.21 516 0.17 777 0.23 opportunity for a new business June 2.38% 2.18% 3.80% unit, commercialized through the July 2.19% 2.13% 3.52% EMPLOYEES WHO LEFT THE COMPANY, BY GENDER GRI 401-1 Hospital. In 2020, an outpatient clinic was opened at Klabin, in August 2.37% 2.23% 3.42% 2018 2019 2020 partnership with SulAmérica, September 2.52% 1.85% 2.56% in the São Paulo headquarters No. Rate No. Rate No. Rate October 2.26% 2.03% 2.62% office, to serve 1,200 lives, among Men 217 0.08 169 0.06 233 0.08 employees and dependents. In November 2.17% 1.99% 3.81% Women 349 0.13 347 0.12 544 0.18 2021, the Institution also won December 2.48% 2.14% 3.80% another client: a hospital in São Total 566 0.21 516 0.19 777 0.28 Medium 2.34% 2.26% 3.45% Paulo with 4,000 employees now 88 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 89

WORK SAFETY Specific efforts were made on the correct use of protective Helping people to live in a equipment and sharp materi- healthy, safe and sustainable als, patient movement, work at way is a concern of the Hospi- height, work with electricity and tal and its work focuses on the risk notification, among others. awareness and engagement of In addition to training, occu- teams to make health and safe- pational safety also carries out ty in the workplace everyone's periodic inspections and moni- commitment. In recent years, toring of the sectors, in order to there was a significant reduc- verify possible risks of accidents tion in the frequency of typical and occupational diseases. accidents.

2018 2019 2020 Frequency of typical accidents 11.64% 14.22% 9.15% Staff development with leave * The positive relationship with and safety. During 2020, the * Occurring during professional activity the clinical staff working at the premises of this relationship Institution – composed of phy- did not change and maintained Clinical Staff sicians of different specialties their structure in four pillars: and dentists– involves engag- PERCENTAGE OF EMPLOYEES RECEIVING REGULAR Management, ing in innovation and research > Clinical Staff Management: it PERFORMANCE AND CAREER DEVELOPMENT ASSESSMENTS GRI 404-3 initiatives, offering benefits and manages the onboarding and Physician building long-term relation- approval of physician regis- ships with those who ensure trations and documentation, 2018 2019 2020 Ombudsman, the success of the Hospital. in addition to detecting their Men Women Total Men Women Total Men Women Total Clinical Staff needs and strengthening their Executive Board 100% 100% 120% 60% 66% 63% 50% 66% 57% The Medical Relationship area is engagement with the Hospital. directly responsible for the ac- The program is linked to the Management 100% 100% 100% 72% 90% 84% 33% 72% 59% Performance tions that include selection, eval- Medical Accreditation Com- Head/coordination 100% 100% 128% 186% 126% 137% 67% 72% 71% Assessment uation and bonus of members mission, the Clinical Board and Technical/supervisor 96% 93% 90% 79% 84% 82% 80% 77% 78% of the active registered clinical the functions under the Chief Program and staff in a value-based health ap- Medical Officer. Administrative 100% 100% 96% 191% 150% 163% 77% 76% 77% the Clinical Staff proach – that is, focused on the Operational 95% 95% 102% 61% 41% 48% 87% 94% 91% patient and their care journey. > Physician Ombudsman: area Trainee 100% 100% 106% 0 6% 4% 57% 37% 43% Academic Program responsible for receiving To recognize the strategic role reports, records, concerns, Total 98% 89% 97% 88% 74.62% 79% 78% 76% 77% are the pillars of physicians and dentists of complaints and compliments the Institution in building its from the clinical staff about * Employees who have been in the institution for 6 months and those who have not been on leave for more than 6 months are eligible for performance evaluation. Interns, apprentices and third-parties do not participate in the annual performance assessment cycle. that guide the reputation and preference for the Hospital. Cases related to ** Performance assessment was conducted in May 2019, and the total number of employees corresponds to December 2019; patients, the Hospital develops ethics, are registered in this thus, employees hired after May 2019 were not considered. Employees who have been in the institution for six months and those who have hospital's medical not been on leave for more than six months are eligible for performance evaluation. a series of measures to engage channel are referred to the staff development the clinical staff on strategies compliance instruments. and challenges of cost-effec- actions. tiveness, sustainability, quality > Clinical Staff Performance Assessment Program: in 2020, 90 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 91

Supply chain GRI 102-9

The Procurement department promptly to the Hospital in the was a particularly important face of challenges. battle front during the Covid-19 pandemic. The Institution relied The changes in Covid-19's med- it included 100% of the active on the punctuality, credibility ical treatment protocols also registered clinical staff with ac- and dedication of its more than posed a challenge over time, as tions aimed at the analysis and 200 suppliers focused on inputs with them came the consequent measurement of medical re- linked to the disease to ensure changes in the necessary sup- sults according to care indica- the supply of essential mate- plies. And, simultaneously , with tors, clinical outcomes, surgical rials, equipment, technologies the sharp drop in the number of performance, patient record and medicines to go through a routine or elective procedures at completeness and capaci- challenging year. the beginning of the pandemic, ty generation of knowledge some items started to remain in and participation in research. The Hospital adopts, as a prem- stock longer. During the year, a review of ise for the management of its performance assessment partners, cost-effectiveness re- As a result of these efforts to instruments and criteria was New opportunity for medical lated to quality and excellence ensure an intelligent and ratio- launched in order to reinforce comfort and coexistence criteria, seeking to standardize nal use of resources, the Hos- the value-based approach. and review its use of materials pital was able to guarantee its and specialized services ac- inputs throughout the period. > Clinical Staff Academic Pro- cording to real needs - such as The first action behind this Agility and planning gram: it is linked to the direct program to not only assess EVOLUTION OF THE those recommended in clin- achievement was to draw up a incentive to the participation the value of each service, but ical protocols and packages list of 96 items that are particu- capacity were of the institution's physi- also to return value to pro- ACTIVE REGISTERED increasingly common in the larly critical in tackling the pan- cians and dentists in research fessionals and their patients CLINICAL STAFF business model. demic and to monitor each one crucial for the and initiatives that generate in the form of safety, quality, (INCLUDING ORAL AND on a daily basis. In addition, at knowledge. In 2020, due to well-being and relationship. As of March, several items with the end of March, the Institution Hospital to be MAXILLOFACIAL DOCTORS the Covid-19 pandemic, there As well as performance eval- much higher than average de- made the decision to maintain able to face the were significant changes in uation, the academic front is AND SURGEONS) mand – waterproof aprons, N95 90-day inventories of of critical patient profiles, treatments reviewing analysis tools and masks, highly complex medica- supplies, a much longer term challenges imposed and financial and academ- scoring metrics. 4,517 tions used in the ICU to stabi- than usual. As these inventories ic-scientific production. This lize patients – began to run the were decreasing, the Procure- by the pandemic only reinforced the belief risk of shortages in the country. ment Department worked with that it is necessary to analyze 4,235 In response, the Procurement long-time suppliers to guaran- quality based on value, and Department implemented a tool tee replacements. 3,927 a great movement to change with “trigger” alerts for some concepts and indicators categories and sought to act began. With this, the Insti- tution began to redesign its

2018 2019 2020 92 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Care in relationships 93

INVENTORY ZERO

Another major mission for 2021 is to Decreasing inventory to the maximum is advance in the Inventory Zero program, something that significantly frees up the which aims to make suppliers take re- hospital's cash flow, contributing to bet- sponsibility for the Hospital's inventory – ter financial results. When Inventory Zero helping with inventory scheduling, re- started, the Institution had inventories in the searching systems and making deliveries amount of R$ 14 million, a number that was according to consumption. With this, we reduced by half before the pandemic arrived seek to increase the frequency of delivery and created an exceptional situation. For Rowa Robot of products, even to up to every 24 hours 2021, the goal is not only to go back to this depending on the input. R$ 7 million level, but also to significantly reduce this number.

AUTOMATION 4.0

The automation project is the biggest Hospital. The area's objective is to rely challenge for the Hospital Procurement more and more on specialist buyers, Department for the near future. Signif- working in synergy with the different ar- icant operational gains are expected eas of the Institution and concentrating with actions such as the automation of their energies on relationships with sup- the follow-up with suppliers and the use pliers and partners, leaving more repet- of artificial intelligence (by means of a itive tasks (such as typing invoices and robot) to eliminate the typing of input follow-up) to the machines. Automation invoices. In the latter case, robotization is considered such an important area was already being used by the Institu- that it is already included in the Strate- tion for medicines and supplies and will gic Plan of Hospital Alemão Oswaldo now be extended to the entire chain, Cruz. Regarding supplier management thinking of gaining efficiency, as well as policies, the approval is pending on tax, quality and safety, a fundamental factor legal and regulatory aspects before any within the Supply Chain Mission of the negotiation or contracting.

New storeroom 94 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Innovation research and education 95

IN THIS CHAPTER > Innovation projects > Teaching and knowledge generation > Future of health and new business Innovation research and education

WE CONTINUE TO SEEK A DIFFERENTIATED POSITION IN PRIVATE HEALTH BY INCORPORATING TRANSFORMATIONS SUPPORTED BY TECHNOLOGY THAT WILL SHAPE THE FUTURE OF THE BRAZILIAN MARKET 6. 96 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Innovation research and education 97

Engagement of the hospital's clinical staff, employees and partners in innovation, research and education activities grew significantly with the pandemic.

The reorganization of efforts The way of working had to be Innovation projects and priorities experienced in adapted to new circumstanc- all areas of the Hospital had an es. The need to adopt distance In 2020, the Innovation area at > Co-development and valida- impact on the Innovation, Re- work came with a learning Hospital Alemão Oswaldo Cruz tion of artificial intelligence search and Education strategy. curve in its implementation and developed a series of proj- for the automated extraction All projects that had the objec- resulted in the incorporation of ects related to combating the of clinical information from tive of combating Covid-19 be- the technologies that make it Covid-19 pandemic. The most medical records, allowed came a priority; several of them possible. The Hospital experi- important were: the Hospital to increase the will bear fruit that will benefit enced an increase in the dyna- assertiveness of a series of the Institution and its patients mism of its internal relations, > Application of artificial processes that permeate even after the health emergen- the digitization and refinement intelligence to support the research activities – thus gency is over. of several processes that gener- interpretation of chest CT erating knowledge in a more ated considerable gains in pro- scans, in order to improve agile and efficient manner. There was a significant increase ductivity in various activities. the diagnosis of Covid-19. in engagement by the clinical This project also resulted > Around a thousand pieces of staff, employees and partners in in tools that help medical personal protective equip- innovation, research and educa- decision by estimating the ment (PPE) were developed tion activities during 2020. The risk of complications in each and produced with 3D print- sense of urgency aroused by patient, as well as optimizing ers and donated to public the outbreak of the pandemic the decision-making process health units. This included a resulted in many new proposals of the management areas as device for the use of non-input forward, while it also helped it anticipates the need for vasive mechanical ventilation form a series of partnerships more advanced resources equipment in patients with (with the industry, startups, or (such as ICU beds), respira- Covid-19, in addition to facial the government). tors and hemodialysis, for supports for a more anatom- example. In a time of scarci- ic fit of non-invasive ventila- ty of space, equipment and tion masks. human resources, these tools not only allowed the Hospital to better manage the flow of patients and the operation of the units, but were also made available to eight health in- The use of artificial intelligence to stitutions – private hospitals and hospitals linked to state support diagnostics and medical and federal universities. and managerial decision-making was one of the most outstanding achievements in the area of Innovation

Technical School Student 98 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Innovation research and education 99

OTHER PROJECTS INTERNATIONAL > GCHF: Largest record of > PURE: Acronym for Prospec- RESEARCH CENTER: heart failure (HF) tive Urban Rural Epidemiol- The fields of virtual reality and HEALTH THROUGH in progress in the world, ogy, it is a global population augmented reality yielded KNOWLEDGE which aims to document study that has followed more great advances in 2020 in inno- demographic, socioeconom- than 300 thousand people vation activities that were not The International Research ic and clinical factors of HF, in almost 30 countries for 12 linked to fighting the pandem- Center was established in order estimating the incidence rate years, distributed in urban ic. This is an area in which the to strengthen the position of outcomes in heart failure and rural areas. In Brazil, pioneering spirit of the Oswaldo of Hospital Alemão Oswaldo patients worldwide. PURE is coordinated by the Cruz stands out. Cruz in the area of knowledge International Research Center

Training of generation, contributing with a > Invictus: Project that involves of Hospital Alemão Oswal- The most important case is, medical teams at the Center for high impact on world science a comprehensive evaluation of do Cruz, which has followed clearly, the use of these tech- Innovation and Health Education and Brazilian medicine and patients with rheumatic heart 6,081 volunteers since 2003, nologies for planning surgical assistance. It is led by Dr. Álvaro valve disease who have atrial identifying over time, through procedures. Once the images Avezum, considered by the fibrillation or atrial flutter, the collection of individu- of exams such as CT scans consultancy Thomson Reuters assessing the prevention of al data, the association of and MRIs are captured, they as one of the four Brazilian sci- stroke or systemic embolism. behavior (lifestyle), environ- are placed in a virtual envi- ogy as soon as possible, also where some professionals entists with the highest impact The drugs used in the study ment, genetics and other fac- ronment so that they can be in education and to improve would participate online, are academic production in the are Rivaroxaban or vitamin K tors to the population's risk manipulated in 3D by physi- the exchange of information also one of the several promis- world in an international ranking antagonists. of illness (from cardiovascu- cian. This technology provides between health professionals. ing possibilities. of 3,215 researchers (2015, 2016, lar events, cancer, respiratory a more immersive experience Partially virtual medical boards, 2017, 2019). and kidney diseases, cardio- and a broader understanding vascular death, cancer death of each situation, helping in The center currently develops and other causes). decision-making even during research in several therapeutic surgical procedures. areas, such as Oncology, Diges- tive System, Infectology, Cardi- The use of virtual and augment- ology, Pulmonology, Endocrinol- ed reality also has great poten- ogy, Nephrology, Rheumatology, tial in the care area – in helping THE TRINETX NETWORK Population Health and Intensive patients to better understand Care. Its premise is to answer Publications a certain procedure they will In 2020 Hospital Alemão Oswaldo Cruz questions of relevance to the undergo, in addition to assist- joined the TriNetX network. Aimed at the population, bringing therapeutic In 2020: 123 articles were published ing in the control of anxiety in research market with Real World Evidence alternatives clinically useful for a hospital environment. These in health, the platform is a repository the community. in high-impact international technologies can also be used of more than 400 million records from newspapers and magazines, such in a rehabilitation scenario, op- around 170 health institutions in 70 coun- The search for alternative timizing the experience during tries. By leading the Brazil cluster on this therapies for the treatment of as The New England Journal of physiotherapy treatments. The platform, the Hospital will be able to gain patients with Covid-19 included technological tools created by precious insights and offer information 23 studies aimed at bringing Medicine, BMJ Global Health, Annals the project are in their approval specific to the Brazilian population. And therapeutic alternatives in the phase. After this stage, the Hos- this should be very useful at a time when fight against Sars-CoV-2. These of Hematology & Oncology, BMC pital intends to use the technol- the lack of ethnic and geographic diver- are of the achievements of the sity among participants in clinical studies International Research Center in Geriatrics, The Lancet, JAMA and has been more questioned as it generates 2020: Circulation, as well as 42 articles more limited results. published in Brazilian journals. 100 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Innovation research and education 101

CARE PATHWAYS PROJECT HEALTH TECHNOLOGY 31 clinical protocols were deliv- COVID-19 BRAZIL COALITION GRI 102-12 ASSESSMENT UNIT ered to the Ministry of Health, Developed by the International with 83 systematic reviews. All Hospital Alemão Oswaldo Cruz was part > Hydroxychloroquine and azithromycin: Research Center, the Care Path- In the context of the pandemic, of this material will be published of this research task force of eight health in line with findings from other global ways Project revolves around the team from the Health Tech- periodically on the website of institutions to conduct clinical studies studies, the Coalition published in the care protocols aimed at a series nology Assessment Unit (UATS, the National Commission for the evaluating therapeutic strategies in inpa- New England Journal of Medicine work of conditions of recognized rel- by its acronym in Portuguese) Incorporation of Technologies tients and outpatients, in order to reduce that pointed out the ineffectiveness of evance in the context of public of the International Research (Comissão Nacional de Incorpo- complications associated with Covid-19. these drugs in combating Covid-19, with health. With a high social and Center produced 18 rapid ração de Tecnologias - Conitec). During 2020, 10 studies were conducted, no variations or indications of benefits financial impact, these diseases systematic reviews to support There will be three methodolog- four of which were completed with publi- among patients who received one or often result in serious events – internal decision-making at ical guidelines: one following the cations in high-impact scientific journals. both, compared to those who received hospitalization and death, main- the Hospital. In addition, this Grading of Recommendations standard treatment. ly – that burden public services expertise allowed the construc- Assessment, Development and significantly. Care Pathways are tion of the Covid-19 Diagnosis Evaluation (GRADE) system, an- > Dexamethasone: the Coalition con- based on good quality scientific and Treatment Guideline with other following technical-scien- ducted a study that identified that the evidence, following the princi- the Ministry of Health – a living tific advice, and the third being a anti-inflammatory dexamethasone ples and guidelines of the Uni- guideline updated every 15 systematic review of randomized helps to decrease the time of use of the fied Health System (SUS), the days, with four versions deliv- clinical trials. artificial respirator in critically ill pa- standards and technical manuals ered and 24 systematic reviews. tients hospitalized with Sars-CoV-2. The of the Ministry of Health and In addition, the UATS team results were communicated in August the rules and services of each participated with the Brazilian NATIONAL RESEARCH & 2020 through publication in the Journal location. Acting with precision, Association of Intensive Care INTERNATIONAL PARTNERSHIP of the American Medical Association at the right time and in the most Medicine (AMIB), the Brazilian NETWORK GRI 102-13 (JAMA). The study was approved by the suitable place is essential to Society of Pulmonology and National Research Ethics Commission raise the quality of healthcare. Tisiology (SBPT) and the Brazil- The International Research Cen- (Conep) and the National Health Sur- ian Society of Infectious Diseas- ter has integrated a collaborative veillance Agency (Anvisa). es ( SBI) in the construction of network with 250 Brazilian insti- Covid-19 guidelines for pharma- tutions that develop studies of > Tocilizumab: a study published by the cological treatment. relevance to the population and Coalition in The British Medical Jour- international institutions. One of nal, in January 2021, points out that these international partners is the analysis with tocilizumab needed to Population Health Research Insti- be stopped after 15 days due to the The excellence of the Hospital led tute (PHRI), a non-profit research increase in deaths among patients who center at McMaster University received the drug. There were also no the Institution to build, together and Hamilton Health Sciences benefits found with the administration Corporation in Canada - where of the drug. with the Ministry of Health, the Dr. Álvaro Avezum is an Interna- tional Research Associate. PHRI's Covid-19 Diagnostic and Treatment mission is to conduct cross-dis- Guideline, a living guideline ciplinary research to improve key health outcomes in common and neglected diseases that affect not only Canadians, but the world population as a whole. The International Research Center of Hospital Alemão Oswaldo Cruz constitutes and represents PHRI in Brazil. 102 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Innovation research and education 103

Education and generation In 2020, several e-learning extension courses were launched, of knowledge reaching 6,795 students, of which 1,570 participated in free courses. In addition, the Under- OUTSTANDING STUDENT The most significant challenges in the area, and the building graduate and Graduate School in 2020 for the education area infrastructure (which includes was accredited as an Distance Tatiane Vinhas de Souza, student of were its relocation in a building the Center for Innovation and 201 Education Institution, and the the FECS undergraduate program in close to the Paulista Campus Health Education, where the Re- in the Nursing Technical Ministry of Education autho- Technology in Hospital Management, and the adaptation of in-person alistic Simulation Center and the Program rized the Hospital Management obtained the highest score among classes to virtual rooms due to Virtual Reality areas are locat- Technology Program, with the all graduates that took the National the social distance measures ed). The complex reached 98.2% maximum grade. The program Student Performance Exam (Enade) adopted against the pandemic. of the indicators assessed, and became part of the group of oth- for this program. Tatiane got 89.2 The coordination and profes- became the first institution 27 er programs already authorized points, against a national average of sors resorted to new techno- of higher education and the in graduate technical or recognized with grade 5.0. 48.9 points. logical resources and worked second of technical education programs in the improvement of active to be certified by Cofen in the methodologies. In addition, state of São Paulo. there were several initiatives to support students with the aim The expansion of the Educa- 93 The Net Promoter Score (NPS) in the of increasing interaction be- tion area is a strategic priority in undergraduate tween them and professors. for Hospital Alemão Oswaldo Education area was 60.5 on average in in- programs Cruz, which works to achieve a Despite the difficulties caused leadership position and to be person education and 92 in online education. by the atypical year, the Techni- increasingly recognized as a cal School of Health Education teaching hospital whose great (ETES) continued on its path healthcare tradition also involves 185 in graduate programs to becoming an growing refer- education. There are currently Even during the Covid-19 pan- ence in its field – mainly in the 34 graduate programs available demic, there was no increase in training of nursing technicians. (8 in the medical field and 26 in dropout rates in the programs, At the beginning of the year, the multiprofessional area, with but a reduction compared to in January, the Federal Nurs- 19 extension programs (read 2019: from the 14.99% regis- ing Council (Cofen) certified more on page 106). tered that year, it fell to a 12.16% through the National Quality in 2020. Program (PNQ) the profes- The goal of increasing sional training complex of the the number of students in Hospital, that houses the Un- the entire area of Education dergraduate, Graduate and the by 60% was achieved with the Technical School. The certifica- incorporation of an expressive tion included the evaluation of number of students in 2020, the training program of nurs- specifically: COFEN Seal and Quality ing technicians and nurses, as Certification Ceremony well as the graduate programs 104 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Innovation research and education 105

CONTRIBUTING TO TACKLING THE PANDEMIC

In partnership with Johnson & Johnson Brazil, the Education area of Hospital Alemão Oswal- process. This new service is assets (such as videos and do Cruz created in 2020 three online courses the result of a Final Thesis infographics) for the insti- related to the health emergency caused by of the MBA in Management tutional support to face the Sars-CoV-2. The Training Program to face the and Innovation in Health, an pandemic. new coronavirus in the Hospital Environment outstanding program of our was aimed at nurses, nursing assistants, nursing School. > The Telemedicine Training technicians and other health professionals who Project, created to raise the are at the forefront of patient care in Covid-19 > Improvement and Innovation awareness of the Hospital's both in the private network as well as in the Contest held in partnership medical team and the scien- public health network. With a 40-hour duration, with the Quality, Safety and tific community in general the first training course focused on a multipro- Clinical Outcomes area. Out on the possibilities of using fessional audience; while the second one, with of 97 projects registered (30 telemedicine safely. a total workload of 100 hours, was oriented to in the Innovation and 67 in Hospital Undergraduate, Gradu- the area of nursing. The third course was the the Improvement fields) 40 > Creation of the extension ate and Technical School Update Program for Community Health Agents qualified for the stage of eval- program in Corporate Health and Agents to combat Endemics to cope with uation (18 of the Innovation Management, designed to the new coronavirus , with a 4-hour duration. and 22 of Improvement fields). help managers make deci- The students of the three training courses re- Three projects were chosen sions amid the challenges ceived certificates awarded by the Institution, as the winners: in the care imposed by the pandemic. totaling 4,798 trained professionals until De- area, a proposal for function- cember 2020. al rehabilitation for Covid-19 > Creation of the Mindfulness patients who went to the ICU; Training extension program in the administrative area, the for the Health Area, which implementation of a new qual- provides scientific and meth- ity control procedure for the odological understanding LEARNING WITH PRACTICE Linear Accelerators for radio- and training of mindfulness therapy, and, in the Innovation techniques – as well as their In 2020, the educational programs conducted in area, a platform for patient psychological and cognitive partnership with the Hospital's healthcare and Other achievements for the > In partnership with the visitors. This platform consists aspects management areas had a considerable expansion, area in 2020 were: Transformation and Care of an interactive and easy-to- becoming one of the main factors to attract more Delivery area, it was creat- use virtual environment for students to the courses. In the Student Develop- ed the Hospital's Support patients and their families with ment and Support Program (PDDA) , undergrad- Service provided by the information on visitors – thus uate and technical education students provide students of the Undergradu- allowing inpatients to monitor support in different processes and workflows in ate, Graduate and Technical visit requests through their the Hospital's healthcare and management areas. Schools. The goal is to offer cell phone, computer or tablet Each sector hosting a student pays for 50% of more comfort and welcome (in order to have autonomy to their tuition fees. to patients and family mem- authorize or deny access). The bers in basic needs such as Information Technology team While in 2019 there were 55 active students food, mobility and movement at the Hospital will develop benefited by the initiative working across nine in beds. In addition, students the software . sectors of the Hospital, in 2020 the number assist with the communica- rose to 141 students immersed in the hospital tion of patients and family > The Innovativ team – the reality – a great differential for students in the members with the medical School's Innovation Labora- Healthcare area. team throughout the whole tory – developed 95 learning 106 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Innovation research and education 107

PROGRAMS

UNDERGRADUATE EXTENSION > Nursing > Mindfulness Training for Healthcare > Technology in Hospital Management Future of healthcare > Corporate Healthcare Management > Radiology Technology and new business > Allergy and Intolerance > Early Childhood Nutrition LATO SENSU GRADUATE PROGRAM IN opportunities THE MEDICAL FIELD > Healthcare Management 4.0 > Bariatric and Metabolic Surgery > Telemedicine Training > Robotic Surgery in Urology > Nutrition in Oncology The pandemic ended up ac- The final goal is to shift the celerating the understanding focus from the reactive model > Clinical Medicine > Project Management in within healthcare institutions and use analytical intelligence journey of each patient, offering Healthcare Organizations > Echocardiography that technology is no longer a so that the Hospital moves from care experiences that match > Health and Wellness Coaching department or the responsibili- contingency to the prediction the expectations and needs of > Advanced Digestive Endoscopy ty of a specific sector. Technol- of complications – and to have patients and health profession- > Best Practices in Quality > Oncological Neurosurgery ogy is increasingly transversal an even greater role in the als in the 21st century. and Patient Safety > Onco-hematology - Clinical practice in lym- to all sectors of the economy > Bed Sore Assessment and Treatment phoproliferative diseases and society.

> Palliative Care: adding Following its recognized innova- LATO SENSU GRADUATE PROGRAM IN value to practice tive tradition, Hospital Alemão THE MULTIPROFESSIONAL AREA Oswaldo Cruz has used technol- TELEMEDICINE > Training for coping with the new coronavirus ogy and data as tools to expand AS A RESOURCE > Pharmaceutical Assistance in Oncology for health professionals the capacity of health profes-

> Oncology Nursing sionals to provide better care: There are great chances that the pandemic has

> Intensive Care Nursing UNIVERSITY EXTENSION PROGRAMS more personalized and efficient. permanently transformed patients' behavior – at least to some degree. The Hospital hired a consul- > Applied Nutritional Genomics > Diagnostic and Therapy Services The Institution's objective is to tant that undertook a study of more than 4,000 > Gerontology > Electronic Health Record and advance towards becoming as people around the world and concluded that Health Information Technology as possible – which patients are increasingly open and desirous of > Management of Nursing Care Services and data driven Practices > Structure of Assistance Services involves everything from opera- digital and virtual interactions and interventions; tional processes to therapeutic either as a complement to the traditional model > Strategic Support for > Mammography Diagnostic Technology and and care decisions. To make this or as a replacement for it. In addition, the practi- Health Institutions Breast Biopsy Methods possible, the Hospital created cality and convenience of telemedicine are espe- > Diagnostic Technology by Computed To- a data laboratory that has a cially important for patients from other cities and

mography and Magnetic Resonance dedicated team. The data lab those who need some form of medical follow-up FREE TRAINING COURSES uses data science and artificial that can be done remotely. For all these reasons, > Precaution, Standard and Isolation intelligence to help the hospi- the Hospital intends to implement telemedicine as > NR32: Safety and Health at Work in Health- tal's medical and management a possibility in even more points of the patient's care Services teams to identify in an ever bet- journey – be it in the private sector, or in the pub- ter way the situations in which lic sector –, making the Institution's excellence in > Hand hygienization a patient will deteriorate or im- care reach more and more places. > NR23: Fire Protection prove – or when an ICU bed or > Elaboration of Scientific Research Papers operating room will be vacant.

108 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Social Responsibility 109

Social Responsibility

IN THIS CHAPTER ATTENTION TO OUR IMPACT ON THE > Impact on Brazilian health COUNTRY'S PUBLIC HEALTH IS A PRIORITY > Instituto Social Hospital Alemão Oswaldo Cruz IN OUR MANAGEMENT MODEL 7. > Proadi-SUS 110 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Social Responsibility 111 PROADI-SUS Where SOCIAL PROADI-SUS can you RESPONSIBILITY findWhere us? SOCIAL PROADI-SUS 18/20 can you RESPONSIBILITY find us?

More than the focus of a specific PROADI-SUS 18/20 area, social aspects inherent to PCDT RHP its activities are something that Clinical research Hospital Alemão Oswaldo Cruz DATs PMedicalCDT Residence takes into account both in the RCCHAPD day-to-day operations and in its IClinicalPA – A nresearchvisa DATs strategic decisions. Integravisa – Anvisa MedicalCollaborative Residence Network CCSaúAdDe em nossas mãos IPA – Anvisa Engagement and dialogue with digiSUS – Manager InditegiSgUraSvi–saInfrastructure– Anvisa the main stakeholders has led CollaborativeDigiSUS - Action Network Plan Saúde em nossas mãos the Institution to evolve in the Strategic Plan dBariatricigiSUS – Manager construction of a sustainability dPrimaryigiSUS –CareInfrastructure DigiSUS - Action Plan agenda and in its capacity to Teleconsultation ImpactStrategic MR Plan contribute to the generation of RegionalizationBariatric RegulaPrimary Mais Care Brasil scientific knowledge and the Teleconsultation promotion of best practices Impact MR Regionalization that, combined, translate into a Impact on Brazilian Regula Mais Brasil greater access for all Brazilians to more effective healthcare healthcare services. GRI 103-2, 103-3 | 203, 203-2, 103-2, 103-3 | 413, 413-1

The activities of Hospital the Brazilian public healthcare Alemão Oswaldo Cruz in the through the administration the and was put to the test again in As a reference in excellence HELP IN FIGHTING COVID-19 IN area of Social Responsibility Specialty Outpatient Center the first quarter of 2021. medicine, due to its matrix THE PUBLIC NETWORK GRI 413-1 are focused on two fronts. On (AMBESP - Ambulatório Médi- structure and accumulated the one hand, the National co de Especialidades Dr. Nelson In this scenario, both Hospi- expertise, Hospital Alemão The level of excellence that Healthcare System Institutional Teixeira) of Complexo Hospitalar tal Alemão Oswaldo Cruz and Oswaldo Cruz impacts the Hospital Alemão Oswaldo Cruz Development Program (PROA- dos Estivadores. and the Field Instituto Social Hospital Alemão well-being of society making showed throughout 2020 in DI-SUS) of the Ministry of Hospital do Complexo Hospi- Oswaldo Cruz are in a leading access to excellent health ser- fighting Covid-19 was also taken R$ 192.7 Health, in which the Institution talar dos Estivadores (Hospital position that will allow them to vices viable From an economic to the public health network. has been active since 2009 and Vitória), all located in the munic- prepare themselves in the best point of view, the issue of job Supporting the Ministry of Health million develops a series of projects, ipal government of Santos (SP). possible way for the complex creation is still pressing: the in the fight against the pandemic in 23 projects developed with R$ 191,098,648 generat- The latter two went into opera- scenario that will emerge from expansion of public healthcare through the National Healthcare under Proadi-SUS during ed in tax immunity during the tion administered by the Institute the post-pandemic. The poten- services, through the Specialty System Institutional Develop- three-year period 2018-2020, in 2020. tial for consulting, for example, Outpatient Center (AMBESP). ment Program (Proadi-SUS) was, the 2018-2020 period with a total of R$ 192,753,133 represents a source of future Dr. Nelson Teixeira of the Field of course, the priority of the year. used in 23 projects. The size of the emergency social contribution, as well as the Hospital and the Covid-19 beds brought by the pandemic was ac- continuity of the positive impact at Complexo Hospitalar dos Es- Through its team from the Health On the other hand, the high- companied by an equally relevant and legacy left on public health tivadores, generated about one Technology Assessment Unit light of the year is that Instituto commitment of specific resources with the administration of hospi- thousand new jobs in the local (UATS), the Institution produced Social Hospital Alemão Oswaldo in the Brazil’s National Healthcare tal and outpatient centers. job market in 2020, directly 18 quick systematic reviews to Cruz, Social Health Organization System (SUS), who showed its and indirectly. In these places, support the hospital's internal advanced in management in structural limitations during 2020 100% of the public receives decision-making and participat- healthcare via SUS. ed in the Covid-19 Guideline for 112 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Social Responsibility 113

NACIONAL SCOPE OF which assisted schools, universities and companies in their THE COVID-19 return to in-person activities in TASK FORCE Instituto Social Hospital order to prevent contamination by the new coronavirus and en- Alemão Oswaldo Cruz sure greater safety. The Hospital • Present in the signed partnerships with Colégio 22 projects focused on management • Imperatriz Leopoldina, Liceu Jar- • 10 training projects • 4 research projects Instituto Social Hospital Alemão dim, Célia Helena, Colégio Hum- • 2 health technology assessment projects Oswaldo Cruz played a key role boldt, among other institutions. in the fight against coronavirus in the public health system in San- At Colégio Humboldt, the Insti-

States with up to 10 SUS institutions benefited tos in 2020, where it managed a tute prepared the new guidelines 110-bed Field Hospital, which had for health security measures of States with up to 30 SUS institutions benefited 590 visits (considering hospital- the school, in compliance with States with more than 30 SUS institutions benefited izations) in the year. the recommendations of the São Paulo Plan, a set of strategies de- At Complexo Hospitalar dos fined by the State Government to Estivadores, in Santos, the entire resume activities in several sec- Diagnosis and Treatment with Another important action of the and generated savings of R$ space was remodeled and floors tors of the economy during the the Ministry of Health (see more Hospital was to provide access to 320 million for SUS. became operative. 40 ICU beds Covid-19 pandemic, as well as the in the Innovation, Research and its Moodle platform, from online were created and 25 medical recommendations of the com- Education chapter). education, so that the gener- In order to enhance the project clinic beds were adapted for petent health agencies, such as al public could have access to management processes, the exclusive care to patients affected the Ministry of Health, the World In addition, the Hospital has repositories of technical content Hospital created in 2018, within by Covid-19. Health Organization (WHO) and developed - also in conjunc- – such as protocols, flows and the Social Responsibility Pillar, Health Surveillance. tion with the Ministry of Health specific care to the treatment of the Knowledge Management The Institute also expanded its - TeleHAOC, a multiprofession- Covid-19– and also to a series of Center. The purpose of this field of action for assistance via al teleorientation portal. This support materials related to the structure is to foster practices specialized consultancy, through initiative allowed public health management of the disease. to gain and share knowledge, professionals from all over the strengthening organizational country to answer questions in Also as part of the projects learning. It structured the Mon- real time about the new corona- developed under Proadi-SUS, itoring and Evaluation of the virus through a multiprofessional the 2018-2020 three-year pe- project portfolio, providing more support, which offered guidance riod was marked by important quality and transparency to the on routines and care processes actions that went beyond what results and giving valuable sup- for health agents working in the was expected for each project. port to the planning process of front line against Covid-19. The Institution acted directly the upcoming 2021-2023 three- in reducing costs through the year period by qualifying pro- The guidelines are provided optimization of care process- cesses and results indicators. virtually by a team formed by es in public hospitals, in direct intensive care doctors and in- support to municipal and state fectologists, nurses, physiother- health managers, in strength- apists, pharmacists, nutritionists ening the clinical pharmacy and and psychologists at the Hos- in reducing infections in ICUs pital, who are also available to of a group of Brazilian hospitals participate in individual tele- exceeding the set goal - reduc- conferences with professionals ing the number of infections by ICU of Complexo Hospitalar from public hospitals. 50%, which saved 2,430 lives dos Estivadores 114 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Social Responsibility 115

EXPANSION: SPECIALTY OUTPATIENT CENTER DR. The management of this Hospi- NELSON TEIXEIRA (AMBESP) tal was shared between the City AND THE FIELD HOSPITAL Government and Instituto Social Hospital Alemão Oswaldo Cruz, Even with the pandemic the by means of an amendment to activities of the Social Institute the contract for the manage- in Santos continued growing. ment of Complexo Hospitalar The Specialty Outpatient Center dos Estivadores. The monthly Dr. Nelson Teixeira, received 68 cost of the unit, R$ 4.8 million, thousand visits, in 24 specialties, was paid with resources from throughout the year -which rep- the State Government. resents 25% of the municipality's population-, using a model based on their resolutive capacity and lines of care.

And all of this in a scenario in AMBESP - Ambulatório Médico de which AMBESP was closed for Administered by the Social Institute, Especialidades Dr. Nelson Teixeira a period at the beginning of the the new AMBESP served the pandemic – shortly after it was inaugurated – for the relocation equivalent of 25% of the population of employees and resources by ESTIVADORES: HUMANIZATION the government. of Santos in six months, with a model AND ADAPTATION TO THE PAN- DEMIC The line of care for type 1 diabe- based on its resolutive capacity and medical beds and 40 ICUs. The areas. Some of the actions led tes created for AMBESP with the Added via public call in 2016, the complex has become one of by the group are conversations support of telemedicine deserves lines of care - with emphasis on the administration of the Complexo the most important points of to guide users about alcoholism, special recognition The pandem- care of patients with type I diabetes, Hospitalar dos Estivadores, em care, diagnosis and treatment diabetes, smoking and sexually ic has made this type of resource Santos (SP), represents a mile- of the disease. transmitted infections, among more accepted (including by reg- with a multidisciplinary approach. stone for the Hospital in terms of others, in addition to addressing ulatory agencies), which opens a generating impact. In order to generate a more sig- awareness actions for internal new front for the Social Institute. nificant impact on society, it was health professionals. The Institution contributes its implemented a set of actions The Field Hospital was opened knowledge in the unit, a refer- following the National Humaniza- in Santos for the treatment of ence in the maternal and child tion Policy. Part of the Specialty Covid-19 cases in the context area in the region, with actions Outpatient Center (AMBESP), of an advance of the pandem- TOWARDS ACCREDITATION to promote the Care Model, an the Humanization Work Group ic in Baixada Santista. Part of intense training program and works to conceive and imple- the United Health Group Brazil, Currently, only 0.3% of Brazilian public investment in quality and safety. ment new humanization initia- owner of the health operator hospitals have international accreditation tives that will benefit users and Amil, Hospital Vitória was ceded (JCI or ACI). Complexo Hospitalar dos With the pandemic, Santos health professionals. free of charge to the municipal- Estivadores is, through the Social Institute, City Government decided to ity through a lending term, valid working to join this select group with the expand: 65 new beds were The group is composed of a mul- until December 31, 2020. Joint Commission International certifica- created to face Covid-19 - 25 tidisciplinary team from different tion. Progress towards this goal has been consistent and has also included intense employee development actions. 116 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Environment and eco-efficiency 117

Environment and eco-efficiency

THE INSTITUTION INVESTS IN THE CONTROL OF IMPACT AND WORKS TO PROPERLY USE THE NATURAL 8. RESOURCES ESSENTIAL TO THE OPERATION 118 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | Environment and eco-efficiency 119

WATER GRI 103-2, 103-3 | 306 EFFLUENTS AND WASTE Environment and efficiency GRI 103-2, 103-3 | 306 The Hospital encourages the conscious use of water through The Hospital has internal routines Even in the pandemic scenario, The environmental impact relat- The indicators include the Pau- ENERGY GRI 103-2, 103-3 | 302 internal communications, the to treat waste and effluents in the routines were maintained ed to the operation are a point lista, Vergueiro and Campo Belo application of technologies to re- line with Resolution RDCN. 222, and the commitment to the of attention for Hospital Alemão Campus and they are managed The Hospital has been working duce water consumption, the use which regulates Good Healthcare correct disposal of recyclable Oswaldo Cruz – which has been in their own system, capable to maintain an internal aware- of reused water and the moni- Waste Management Practices. materials (which grew by 22.64% undertaking a series of efforts in of detecting variations and the ness policy on the use of energy toring of the use of the resource in the year) demonstrates this favor of greater energy efficien- need to increase efficiency in through the use of communi- (which may be restricted when Monitoring and evaluation of evolution. There was also an in- cy in its projects for new units the Hospital's facilities. cations and the application of applicable). In 2020, the policies this indicator are carried out crease in the generation of waste and towers, less water consump- technologies to reduce con- for internal awareness of water by the Institution's Workplace associated with assistance due tion and a more efficient waste sumption, with emphasis on use, application of technologies Safety and Environment area. In to the high occupation resulting management. automation tools. to reduce consumption and use addition, audits are carried out from Covid-19 and the various of reused water were maintained. periodically in the areas to verify precautions necessary to protect compliance with disposal, identi- patients and employees. fication and awareness. Spending on waste treatment and disposal FUEL CONSUMPTION was R$ 1,047,924.66 in 2020. FROM NON-RENEWABLE SOURCES (GJ) GRI 302-1

2018 2019 2020

Piped gas supply São Paulo 13,774.97 13,102.66 14,654.57 Diesel fuel 1,111.50 876.00 1,029.85 TOTAL VOLUME OF WATER COLLECTED IN ALL AREAS Total 14,886.47 13,978.66 15,684.43 AND AREAS UNDER WATER STRESS, BY SOURCE (ML) GRI 303-3

2018 2019 2020

Groundwater (Total) NA NA 3,337.00 ENERGY CONSUMED (GJ) GRI 302-1 Third party water (Total) 137,981.00 194,602.02 169,009.00

2018 2019 2020 Total 137,981.00 194,602.02 172,346.00 Electricity 69,727.82 89,312.13 97,627.61

EFFLUENTS AND WASTE GRI 306-2

Hazardous Waste 2018 2019 2020 TOTAL ENERGY CONSUMED (GJ) GRI 302-1 disposal (tons) Incineration (mass burn) 63.65 91.26 131.22 2018 2019 2020 Landfill 510.01 394.94 526.12 Nonrenewable fuels 14,886.47 13,978.66 15,684.43 On-site storage 0.00 0.863 0.429 Energy consumed 69,672.08 89,312.13 97,627.61 (radioactive waste) Total 14,027.66 10,649.06 10,861.76 Total 84,558.55 101,425.27 113,312.03 120 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | GRI Contents 121

Other correct disposal practices are continuously implemented at the Hospital, including technological waste, batteries, veg- etable oil, cigarette butts and the reverse logistics of plastic packaging. Plastic packaging is disposed of in partnership with a manufacturer that guarantees the correct disposal of waste.

DISPOSAL OF NON-HAZARDOUS WASTE (TONS) GRI 306-2

2018 2019 2020

Recycling 216.83 235.23 288.48

Landfill 1,070.17 1,163.87 1,174.69

Total 1,286.99 1,399.10 1,463.17 In 2020, the Campo Belo Campus had unified monitoring in relation to the amount of non-hazardous waste (recyclable + landfill). Individualized monitoring began in 2021

GRI Contents

Waste Recycling. 122 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | GRI CONTENTS 123

GENERAL DISCLOSURES GENERAL DISCLOSURES

GRI Standard Disclosure Page/URL Omission SDG GRI Standard Disclosure Page/URL Omission SDG

GRI 101: Foundation 2016 Stakeholder engagement

GRI 101 has no content GRI 102: General 102-42 Identifying and selecting stakeholders 47 disclosures 2016 Organizational profile 102-43 Approach to Stakeholder Engagement 47 and 80

GRI 102: General 102-1 Name of Organization 12 102-44 Key topics and concerns raised 47 and 80 disclosures 2016 102-2 Activities, brands, products and services 12 Reporting practices

102-3Location of organization's headquarters 12 GRI 102: General 102-45 Entities included in the consolidated 5 disclosures 2016 financial statements 102-4 Location of operations 16 102-46 Defining report content and topic 5 Boundaries 102-5 Ownership and legal form 12 102-47 List of Material Topics 47 102-6 Markets served 16 102-48 Restatements of information Indicators with 102-7 Scale of the organization 16 data reformulation or revision are de- 102-8 Information on employees and other 84, 85 and 86 8.10 tailed in a footnote workers or in the text.

102-9 Supply chain 91 102-49: Changes in reporting 5

102-10 Significant changes in the organization 19 102-50: Reporting period Jan/1/2020 to and its supply chain Dec/31/2020.

102-11 Precautionary principle or approach 66 102-51 Date of most recent report April 2020

102-12 External initiatives 100 102-52 Reporting cycle Annually

102-13 Membership of associations 101 102-53 Contact point for questions regarding 5 the report Strategy 102-54 Claims of reporting in accordance with This report has been prepared in GRI 102: General 102-14 Statement from senior decision-maker 8 and 10 the GRI Standards accordance with the GRI Stan- disclosures 2016 dards Core option.

Ethics and integrity 102-55 GRI Content Index 122

GRI 102: General 102-16 Values, principles, standards and norms 24 16 102-56 External assurance None. disclosures 2016 of behavior

Governance

GRI 102: General 102-18 Governance structure 24 16 disclosures 2016

Stakeholder engagement

GRI 102: General 102-40 List of stakeholder groups 47 disclosures 2016 102-41 Collective bargaining agreements All employees are covered by 8 collective bargaining agreements. 124 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | GRI CONTENTS 125

MATERIAL TOPICS MATERIAL TOPICS

GRI Standard Disclosure Page/URL Omission SDG GRI Standard Disclosure Page/URL Omission SDG

Economic Performance Anti-corrpution

GRI 103 103-1 Explanation of the material topic and its 48 GRI 103 103-1 Explanation of the material topic and its 48 Management boundary Management boundary approach 2016 approach 2016 103-2 The management approach and its com- 70 103-2 The management approach and its com- 28 ponents ponents

103-3 Evaluation of the management approach 70 103-3 Evaluation of the management approach 28

GRI 103 201-1 Direct economic value generated and dis- 71 8.9 205-3 Confirmed cases of corruption and mea- 28 16 Management tributed sures taken approach 2016 201-3 Obligations of the defined benefit plan The Hospital has Power and other retirement plans a defined contribution plan with GRI 103 103-1 Explanation of the material topic and its 48 minimum, regular Management boundary or additional match approach 2016 103-2 The management approach and its com- 118 contributions ponents depending on employee contri- 103-3 Evaluation of the management approach 118 butions. The employer’s minimum GRI 302: 302-1 Consumption of energy within the orga- 118 7, 8, 12, contribution is 1% Energy 2016 nization 13 of a participant’s contribution Water and effluents salary, limited to R$ 5,824.11 (as of GRI 103: 103-1 Explanation of the material topic and its 48 March 2020). It is Management boundary the employer's obli- approach 2018 gation to make the 103-2 The management approach and its com- 119 promised contribu- ponents tions up to the date 103-3 Evaluation of the management approach 119 of the participant's eligibility for the benefit or until his GRI 103: 303-1 Water interaction as a shared resource 119 6, 12 or her termination Management - or until his or her approach 2018 303-2 Management of water discharge-related Decree 8468 - 6 disability or death impacts. ART 19A, Consol- is attested. idation Ordinance 5, RDC 11, NBR 201-4 Financial assistance received from the The government does not partic- 17665. government ipate directly nor indirectly in the Institution's operations. 303-3 Water withdrawal 119 6, 8, 12

Indirect economic impacts Effluents and waste

GRI 103 103-1 Explanation of the material topic and its 48 GRI 103 103-1 Explanation of the material topic 48 Management boundary Management and its boundary approach 2016 approach 2016 103-2 The management approach and its com- 110 103-2 The management approach and its com- 119 ponents ponents

103-3 Evaluation of the management approach 110 103-3 Evaluation of the management approach 119

203-2 Significant indirect economic impacts 110 1, 3, 8 306-2 Waste by type and disposal method 119 3, 6, 12 126 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | GRI CONTENTS 127

MATERIAL TOPICS MATERIAL TOPICS

GRI Standard Disclosure Page/URL Omission SDG GRI Standard Disclosure Page/URL Omission SDG

Employment GRI 416: 416-1 Assessment of the health and safety im- 66 Customer Health pacts of product and service categories GRI 103 103-1 Explanation of the material topic and its 48 and Management boundary Safety 2016 416-2 Incidents of non-compliance concerning There was no fine, penalty 16 approach 2016 the health and safety impacts of products and or warning applied 103-2 The management approach and its com- 81 services to the Institution. ponents Marketing and Labeling 103-3 Evaluation of the management approach 81 GRI 103 103-1 Explanation of the material topic and its 48 GRI 401: 401-1: New employee hires and employee turn- 86 5, 8, 10 Management boundary Employment over approach 2016 2016 103-2 The management approach and its com- 66 401-2 Benefits provided to full-time employees 85 3, 5, 8 ponents that are not provided to temporary or part- time employees 103-3 Evaluation of the management approach 66

Training and education GRI 417: 417-1 Requirements for product and service The Institution has 12 Marketing and information and labeling policies to regulate GRI 103 103-1 Explanation of the material topic and its 48 Labeling 2016 the purchase, avail- Management boundary ability/transporta- approach 2016 tion, storage and 103-2 The management approach and its com- 82 monitoring of haz- ponents ardous materials, 103-3 Evaluation of the management approach 82 as well as FISQP (Chemical Safety Information Sheet) GRI 404: 404-1Average hours of training per year, per 84 4, 5, 8, guidelines available Training and Edu- employee 10 to all employees, cation 2018 404-3 Percentage of employees receiving 88 5, 8, 10 third parties and regular performance and career development partners. There is a reviews healthcare service waste manage- Local communities ment program that monitors and man- GRI 103 103-1 Explanation of the material topic and its 48 ages the possibility Management boundary of environmental approach 2016 impact of waste 103-2 The management approach and its com- 110 generated by ponents health products. 103-3 Evaluation of the management approach 110 Customer Privacy

GRI 413: 413-1 Operations with local community engage- 111 GRI 103 103-1 Explanation of the material topic and its 48 Local Communi- ment, impact assessments, and development Management boundary ties 2016 programmes approach 2016 103-2 The management approach and its com- 28 Consumer Health and Safety ponents

GRI 103 103-1 Explanation of the material topic and its 48 103-3 Evaluation of the management approach 28 Management boundary approach 2016 103-2 The management approach and its com- 66 GRI 418: 418-1 Substantiated complaints regarding 28 16 ponents Customer Privacy breaches of customer privacy and losses of 2016 customer data 103-3 Evaluation of the management approach 66 128 Hospital Alemão Oswaldo Cruz INTEGRATED REPORT 2020 | GRI CONTENTS 129

CERTIFICATIONS AND AWARDS

2003 2005 2007 2008 MATERIAL TOPICS

GRI Standard Disclosure Page/URL Omission SDG

Social and economic compliance ONA Level 2 Certification ONA Level 3 Certification Temos Certification ONA Level 3 Re-certification Integrated Management Excellence Excellence GRI 103 103-1 Explanation of the material topic and its 48 Management boundary 2009 2010 2011 approach 2016 103-2 The management approach and its com- 28 ponents

103-3 Evaluation of the management approach 28 Bariatric Surgery Center JCI Accreditation Temos Certification Prêmio Gestão Certification com Qualidade GRI 419: 419-1 Non-compliance with laws and regula- We do not receive significant 16 2012 2013 Socio-economic tions in the social and economic area fines or penalties Compliance 2016 for failure to comply with laws and regulations. Well-Being Program Temos Certification Nutrition Service OBED Endoscopy Center JCI National Quality of Health Award Green Kitchen Mark Certification Reaccreditation Life Awards Wellness Program

2014 2015

As Melhores da JCI: Extension survey - OBED Endoscopy Center Dinheiro: Best Tower E Certification Healthcare Company in Brazil JCI Reaccreditation Sustainable Development Goals

1. No poverty 2015 2016

2 Zero hunger and sustainable agriculture

3. Health and well being As Melhores da Dinheiro: Certification Bariatric Surgery Center Latin American Hand JCI Best Healthcare Company 4. Quality Education Leed Gold Re-certification Hygiene Excellence Award in Brazil

5. Gender Equality 2017 6. Clean water and sanitation

7. Affordable and clean energy Best Companies for Aberje Award Aberje Award National Quality 8. Decent work and economic growth Occupational Health and São Paulo Amigo Media Communications Print Media of Life Awards Safety —ANIMASEG do Idoso Program and Relations LEVE 9. Industry, innovation and infrastructure 2017 2018 2020 10. Reducing inequalities

11. Sustainable cities and communities As Melhores da Din- Aberje Award Aberje Award Nutrition JCI 12. Responsible consumption and production heiro: Best Healthcare Print Media Digital Media Service Green Reaccreditation Company in Brazil LEVE Kitchen Mark Great Place to Work 13. Climate action

14. Life below water 2018 2019 15. Life on land

16. Peace, justice and strong institutions Certification of Undergraduate Global Healthy Automation Awards Bariatric Surgery As Melhores da Nutrition 17. Partnerships for the goals , Draduate and Workplace 2018 Center Re-certifi- Dinheiro: Best Service Green Technical School - Awards cation Healthcare Kitchen Mark Cofen Seal Company in Brazil 130 Hospital Alemão Oswaldo Cruz

INTEGRATED REPORT 2020 HOSPITAL ALEMÃO OSWALDO CRUZ

Management PAULO VASCONCELLOS BASTIAN Chief Executive

General Coordination MELINA BEATRIZ GUBSER Corporate Communications Manager

Editorial Coordination MICHELLE BARRETO Corporate Communications Coordinator BIANCA RIBEIRO Corporate Communications Analyst

English translation MS TRADUÇÃO JURAMENTADA E TÉCNICA

Production Support RAFAELA ROSAS Corporate Communications Analyst

Graphic and editorial design, editing and GRI consulting REPORT SUSTENTABILIDADE

Photos LALO DE ALMEIDA ROBERTO ASSEM IMAGES FROM THE HOSPITAL'S COLLECTION

Print FORMA CERTA Integrated Report 2020 INTEGRATED REPORT 2020

Paulista Unit Rua Treze de Maio, 1.815 Bela Vista CEP 01327-001 HOSPITAL ALEMÃO OSWALDO CRUZ São Paulo-SP Tel.: 11 3549 1000

Campo Belo Unit Avenida Vereador José Diniz, 3.457 Sobreloja Campo Belo CEP 04603-003 São Paulo-SP Tel.: 11 2344 2700

Vergueiro Unit Rua São Joaquim, 36 Liberdade CEP 01508-000 São Paulo-SP Tel.: 11 3549 1000

www.hospitaloswaldocruz.org.br

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