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VISÃO HOSPITALAR MAGAZINE
THE IMPORTANCE OF THE HOSPITAL
The hospital is a medical and social organization whose function is to provide the entire population with comprehensive, curative and preventive medical care, in addition to being a center for education and research in health.
The current scenario has placed the hospital in the center of all attention, as it recognizes its importance and role at this time and knows how we really need this attention. For some time now, we have demonstrated the situation faced by hospitals, such as the high tax burden, the request for special credit lines, the need for qualification of all professionals working in the segment, the importance of innovation and technology for the entire chain, and , in the midst of all this struggle, there is a much bigger challenge: the search for adequate treatments and procedures, as well as qualified labor to face this challenge that is the coronavirus.
The Health Sector requires more than investment and attention; it requires Adelvânio Francisco Morato planning to remain one of the most promising areas for the development President of FBH of our economy and the country. We need to strengthen all hospitals, expand the number of beds in our country and the capacity to provide care for each one, so that we can provide safe, qualified and adequate care for our population.
As a pioneer entity in the representation of Brazilian hospitals, FBH has been leading, alongside partner institutions, historical claims that, at this moment, require special attention. WORD FROM We will continue on this journey, joining efforts with the main institutions THE PRESIDENT and authorities that operate in the segment to effectively contribute to the development of our hospitals and professionals.
Congratulations to all professionals and hospitals who are standing strong in their mission!
Adelvânio Francisco Morato President of FBH
EXECUTIVE BOARD PRESIDENT GENERAL SECRETARY CULTURAL ACTIVITIES’ SUPERVISORY BOARD - Adelvânio Francisco Morato Luiz Aramicy Bezerra Pinto DIRECTOR ALTERNATE MEMBERS Marcus Camargo Quintella Roberto Vellasco VICE-PRESIDENT DEPUTY SECRETARY Maurício Souto Maior Altamiro Bittencourt Ivo Garcia do Nascimento SUPERINTENDENT Benno Kreisel Eduardo de Oliveira Luiz Fernando C. Silva Manoel Gonçalves Carneiro Netto DIRECTOR TREASURER BOARD DIRECTORS Reginaldo Teófanes de Araújo Mansur José Mansur SUPERVISORY BOARD - ADVISORS Francisco José Santiago EFFECTIVE MEMBERS Leonardo Rocha Machado de Brito DEPUTY TREASURER Fernando Antônio Honorato Ibsen Pontes Moreira Pinto José Pereira Glauco Monteiro Cavalcanti da Silva e Souza Mauro Duran Adan Manso Leonardo Gigliotti Barberes Élson Sousa Miranda Edivardo Silveira Santos
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Chief editor Viviã de Sousa - 12118/DF THE EDITOR [email protected]
Graphic Project Overcoming a crisis Viva Comunicação Group vivacomunicacaogroup.com In commemoration of National Hospital Day and World Marketing Hospital Day, in this edition we deal with the scenario [email protected] of the evolution of this important establishment for
Executive production our segment and for the whole country. Rosana Oliveira [email protected] We also interviewed senator Izalci Lucas (PSDB/DF), who spoke about one of the greatest lessons learned Translation and Proofreading from the pandemic: the importance of investment in Jaqueline Rodrigues Guilherme Franco Santos health and how this crisis mainly affected small and medium-sized hospitals in Brazil. Content production Felipe Nabuco The portrait of the Brazilian hospital network, made by [email protected] Luiz Fernando C. Silva, superintendent of the Brazilian Print run Hospital Federation (FBH), demonstrates the effects 7 mil exemplares of the pandemic on the management of service Art and Layout providers and the numerous challenges faced by the Viva Comunicação Group entire sector. vivacomunicacaogroup.com And when it comes to investment, we present the fund Publication Quarterly created by Bioxxi, the largest company in Latin America in the sterilization of health products, which aims to help hospitals in this moment of crisis aggravated by the pandemic.
Overcoming this crisis is due to the effort of all those who went beyond their limits to promote actions, paths and opportunities that would contribute to the development and solution of the problems facing the area. Our goal is to promote strategic content to help our readers visualize new horizons.
Federação Brasileira de Hospitais - FBH ENJOY YOUR READING SRTVS Qd. 701 - Conj E - nº 130 - 5º andar Ed. Palácio do Rádio I - Torre III - Brasília-DF Viviã de Sousa | Chief Editor 70340-901 Tel: (61) 3044 0332 E-mail: [email protected] ARTICLES AND REPORTS
GESTÃO DA QUALIDADE 08
CANNABIS MEDICINAL 10
VISÃO INTERNACIONAL 12
HOSPITAL REFERÊNCIA 18
GESTÃO DE PROJETOS 20
AHEG 25
GESTÃO DE PESSOAS 30
INTERNACIONAL 32
INOVAÇÃO 34
GESTÃO 36 COVER MARKETING 38 MEDICINA DIAGNÓSTICA 40 TRANSFORMAÇÃO HOSPITALAR 06 NEGÓCIOS 42 REDE HOSPITALAR 22 VISÃO JURÍDICA 45 ENTREVISTA 15 PLANOS DE SAÚDE 47 INVESTIMENTO 27 INOVAÇÃO E SAÚDE 49 TELEMEDICINA 51
SAÚDE DIGITAL 54
FALA GESTOR 56
ENERGIA 58
EVENTS AND INDICATORS
ACONTECE NO CONGRESSO 60 CALENDÁRIO DE EVENTOS 62 ÍNDICES ECONÔMICOS 64 HOSPITAL TRANSFORMATION
HOSPITAL TRANSFORMATION IN THE COURSE OF THE PANDEMIC
By Felipe Nabuco [email protected]
Organizational resilience, to changes, which permeated the transformations in adaptability, technological care and in the organization of health services. incorporation and investment The scenario of crowded emergencies, patients dying while waiting for beds, overworked professionals, in people training. How shortage of supplies and medicines, among others, are hospitals reinventing was one of the biggest challenges ever imposed on the Brazilian health system. Added to this context is themselves during the the need to face an enemy that is still little known, as worst time of health crisis in well as its destructive power. centuries? Far beyond technological innovations, it was necessary for hospitals to also look inwards, to the way they The pandemic caused by the new coronavirus manage, analyze and optimize internal processes, how catalyzed changes in care and hospital management, the existing methods and methodologies work and which have long been identified as necessary by the are adapted to institutional scenarios and cultures. sector itself. An example of this is the incorporation For those who had nowhere to look for inspiration, of digital technologies that have become realities it was necessary to seek solutions within the current in hospitals around the world for more than two scenario. And this was one of the biggest challenges decades, but were left aside in Brazil. posed by the crisis: how to do more and better with the same, or even with less? However, this accelerated modernization process, as expected, did not linearly encompass the entire The ability to adapt to changes, as well as Brazilian hospital network, which today is mostly organizational strength and resilience, led the sector (70%) composed of small and medium-sized to redefine organizational flows, to adopt new care hospitals. In most of these establishments, it was not protocols, to force discussion about the difficulties technology, but the very ability to reinvent and adapt faced by the economic and industrial health
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“Transforming current problems into opportunities for improvement, so that hospitals can leave this pandemic with more management maturity, especially with regard to people's preparation, organizational resilience and capacity for change, is still the greatest challenge.“
complex, which lead to the proper functioning of the several countries, these technologies have been a production chain, as well as to invest significantly in reality since the 1990s. the training of professionals. This accelerated digital transformation, however, One of the immediate consequences of this process also reveals imminent challenges for the Brazilian is the strengthening of safety protocols against hospital network. One of them concerns the hospital infection, as well as the dissemination of urgent adaptations to the General Data Protection collective self-awareness for preventive actions, Regulation (In Portuguese, Lei Geral de Proteção de such as attention to hand hygiene, care with the use Dados - LGPD). Another challenge shows that it will be of masks, among others. necessary to implement a State policy that mitigates the consequences of the abyss that only increases In relation to professional qualification, the moment between small and medium-sized establishments of crisis also showed how essential it is to have and large hospital complexes. trained professionals ready to coordinate, both in the care and management areas, teams in such It is a fact that the country needs to recognize the adverse situations, especially during peak moments strategic and sustainable importance that these small of the pandemic. Establishing training routines and establishments have for the national health system, preparing leaders became an ongoing strategy in the especially in inner cities, where they are the only planning of each establishment as a way to prepare care option for millions of Brazilians (seven out of for unpredictable situations. ten are located in cities from the interior). Today, they represent about 70% of all hospital establishments The much-talked-about incorporation of technology, in the country, and more than half perform care as of course, also enabled significant impacts on hospital service providers by the Unified Health System (SUS). transformation. From the perspective of the debate, it would not be an exaggeration to say that Brazil has Every moment of difficulty can bring reflection managed to achieve more in this single year than the and learning. Transforming current problems into last 30 years combined. At least, this is the period opportunities for improvement, so that hospitals can in which important themes in hospital care, which leave this pandemic with more management maturity, are now gaining prominence, such as telemedicine, especially with regard to people's preparation, electronic medical records and digital self-service organizational resilience and capacity for change, is systems, have been discussed in different fields. In still the greatest challenge.
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PATHS TO EXCELLENCE IN HEALTH
Health care requires new approaches, in which the generation of value for citizens is an essential RAFAELA VERONEZI criterion in any care Physiotherapist, PhD in Medical Sciences, provided. corporate manager of Teaching and Research at the Association for Management, Innovation and Results in Health.
In organizations of any nature, excellence does end, as it involves continuous improvement and there not happen instantly. In health, this reality is no is no guarantee of its continuity. different. The high standard involves issues related to assistance that obviously permeate management. It is Implementing improvements requires more than a gradual process, a path that must be followed with good ideas and good will. It takes an attitude for the determination and obstinacy. constant improvement of processes and the acumen of change to carry out things, under penalty of being This does not mean that all health institutions have a stuck with pre-established and outdated models. similar trajectory. On the contrary. We have observed, historically, that several entities do not start at exactly Currently, in healthcare organizations, the pursuit of the same point and do not reach the same parity. Each excellence is focused on improving the experience one builds its own path and has its own evolution of patients, with greater cost-effectiveness. It means time, depending on the maturity of its management. to say that the services must be prepared to meet the population's health demands with quality and However, the most important perception is the safety, observing the priorities and assistance profile understanding that we must act seeking excellence, of each unit. knowing that this is not an absolute and immutable
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In this case, the focus on the user's needs comes costs, meteoric technological advances, in addition to first, and the consequences of this end up generating regulatory pressures, make the pace of transformation improvements in all aspects involved. That is, it is slower than desirable. necessary for professionals to see the importance of the empathic dimension, in which human relationships In healthcare, as in any other professional area, there are defined not only in the provision of services, but is no guarantee of excellence without hard work. We in the delivery of value, prioritizing results from the need to generate information from concrete data and perspective of the protagonist of care: the patient. consistent structures. More and more, we need to awaken, in the health teams, the interaction to play As long as health is seen as just an expensive budget a leading role with all the characters working in the item, its policies will be seen as short-term investments. system – which is complex, but rewarding, as it handles Health care requires new approaches, in which the and saves countless lives. generation of value for citizens is an essential criterion in any care provided. But how to get there? Here comes a new era… the road ahead is treacherous. It is only achievable with a lot of dialogue, teaching Implementing any organizational change is particularly and research, humanization and love for the patient. challenging; however, it is perfectly possible and Only then we will be able to make tangible changes to feasible. However, limited financial resources, rising our healthcare system, of which we are all users!
| 9 MEDICINAL CANNABIS
THE PAST OF AN ANCIENT ART. THE PRESENT AND FUTURE OF A FASCINATING SCIENCE
The medicinal use of cannabis has been known in Despite the unfavorable backdrop, scientists continued many cultures for more than 5.000 years, taking us to study the use of medicinal cannabis as an adjunct back to the era that precedes the written word. We therapy in the treatment of neurological, psychiatric, know that cannabis traveled the entire Silk Road that degenerative and inflammatory diseases. commercially connected the East and Europe, being taken to the West by the Scottish physician William Known as the “father of modern cannabis”, O'Shaughnessy while participating in the British researcher Raphael Mechoulam, in partnership with missions in the Indies. the Hebrew University of Jerusalem, managed to isolate 60% of the active substance in cannabis with As a researcher and professor at the University of laboratory methods synthesizing, for the first time, Calcutta (India), William O'Shaughnessy was one of THC (tetrahydrocannabinol) and, later, cannabidiol, the pioneering scientists in the research of cannabis compounds of the plant. His study, published in the therapies in patients with cholera, rheumatism, rabies, journal Science in 1970, approaches the biogenesis of tetanus, epilepsy and inflammatory diseases, studying cannabinoids in an unprecedented way. the substance's benefits in the pain relief and reduction of muscle spasms. The discovery and elucidation of the endocannabinoid system allowed for a wide range of preclinical studies The use of medicinal cannabis gained prominence in to be carried out, enabling the first clinical trials in the Europe and, later, in the United States, between the area to be conducted. In 1980, Raphael Mechoulam years of 1840 and 1940. English doctors indicated the and Brazilian professor Elisaldo Carlini, from the use of the plant as an appetite stimulant, analgesic, Federal University of São Paulo (Unifesp), together muscle relaxant, anticonvulsant and hypnotic. published the first study with humans on the use of medicinal cannabis in patients with drug-resistant However, due to ideological and political issues, as well epilepsy, demonstrating the substance's benefits in as the lack of quality control and basic knowledge of controlling epileptics seizures. the pharmacology and chemistry of the plant, cannabis went through a period of obscurantism in the last More than a century after the publication of the first century, being banned in many countries, especially by works of Modern Medicine with medicinal cannabis, the growth of its recreational use. we know that the plant has more than 480 chemical
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substances. About 150 of these compounds are by multiple sclerosis, in the control of epileptic seizures called phytocannabinoids, and the best known and and other conditions. These benefits have significantly most studied are THC (tetrahydrocannabinol), CBD contributed to the quality of life of patients. (cannabidiol) and CBG (cannabigerol). The advancement of scientific knowledge about Science has already discovered that phytocannabinoids medicinal cannabis and the development of the bind to specific receptors in the human body. This specialized pharmaceutical industry show that we are complex system is responsible for a number of facing an innovative scenario in which the substance physiological functions, including memory, mood, can be classified as a new therapeutic area available to motor control, eating behavior, sleep, immunity and support different medical specialties. Cannabis-based pain. Thus, studies show the benefits of treatment for phytopharmaceuticals are developed through rigorous certain diseases, such as in the non-motor symptoms quality controls, with 99% purity and defined indications of Parkinson's disease (depression, anxiety, sleep that can respond to the unmet needs of patients. disorders and others), in the pain and spasms caused
FLAVIO REZENDE Studies show the benefits of treatment Master and Doctor in Neurology. Professor at for certain diseases, such as non-motor the Department of Clinical Medicine at the Federal University of Rio de Janeiro (UFRJ) symptoms of Parkinson's disease and Director of Research and Development at (depression, anxiety, sleep disorders and Health Meds. others), in the pain and spasms caused by multiple sclerosis, in the control of epileptic seizures and other conditions.
| 11 INTERNATIONAL VISION
THE ORGANIZATION OF THE GERMAN HOSPITAL SYSTEM AND ITS PERFORMANCE IN THE FIGHT AGAINST COVID-19
A fundamental facet of the German healthcare system The DKG bundles and advocates their interests in in general and the hospital sector in particular is all health politics at the national, European and the sharing of decision-making and responsibilities International level. On the other hand, the DKG was between the federal, the regional, and the local level. and is assigned with a continuously growing list of At each level, various actors interact to fulfil specific responsibilities with regard to the principle of self- duties to their respective role. Whereas the on-site governance. organisation and planning of hospital care remain the exclusive responsibility of the regional and local level, The objective of this article is not to decode the main issues to decide on the national level are quality complex multi-layered German healthcare system, but standards and financing mechanisms. to provide you with a first overview. The report starts with a look at the German hospital landscape that At the national level, the government and parliament helps us, in the second part, to reflect on Germany’s set basic definitions and objectives by Federal law and COVID-19 response in 2020. the actors of the “self-governance system” –healthcare providers and health insurance providers sickness funds – negotiate and decide on the binding details. GERALD GASS In this very complex multi-layered healthcare system, Sociologist and PhD in economics. Chairman the German Hospital Federation (DKG – Deutsche of the Board of the German Federation Krankenhausgesellschaft e.V.) is the representative of Hospitals (DKG). Member of the Board body of all German hospitals regardless of their type of Directors of the International Hospital of ownership. Public, private-for-profit and private- Federation (IHF) and of the Board of Directors not-for-profit, or charity based hospital owners are of the European Federation of Hospitals and Health (HOPE). united in the DKG via its member organisations.
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OVERVIEW OF THE GERMAN gateway for innovation in the healthcare system and HOSPITAL SYSTEM are very active in research and development, especially amongst the 35 German university hospitals. The approximately 2.000 German hospitals in private, public or non-profit ownership provide healthcare to In a viable network, German hospitals assure high- more than 19 million patients on an inpatient basis. quality medical care to all patients throughout the Additionally, they provide services to another 20 country. Besides the nationwide quality standards million outpatients which constitutes a continuously outlined by national law and specified by the actors growing share, including delivering highly specialized of the “self-governance system”, hospitals take a wide ambulatory care or outpatient treatments in so-called range of measures to assure and improve quality and “ambulatory care centres”. patient safety at national, regional, local and divisional level and by every employee, on their own initiative, In dialogue with partners in politics and self- and on a daily basis. government on a permanent basis, DKG is working on overcoming the previously strict borders between Every clinic mandatorily submits ongoing data on primary and hospital care. The care is provided by 1.2 more than 400 structure-, process- and outcome- million employees, constituting the key to the success quality indicators to an external institute. Lacks of of Germany’s hospitals and high quality of care. quality performance are detected and hospitals must Roughly 170.000 full-time-doctors and 350.000 full- demonstrate improvement measures. In addition, a so- time-nurses accept their continuous responsibility for called “structured quality report” is created and must the health of the patients. Germany’s hospitals are the be published by the hospital, providing evidence to
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patients to empower them with well-informed choices. equipped with ventilation capability. On average, These reports are, at the same time, the data basis for these were occupied 80 to 90 percent. In a joint effort, the official “German hospital directory” where patients these capacities were expanded nationwide. Over can browse for the hospital of their preference. This the course of the pandemic, the number of operable search engine is also available in English and provides ICU beds with ventilation capability suitable for a special search option for international patients Covid-19 patients was increased to more than 28,000. (www.german-hospital-directory.de). Furthermore, a reserve of approximately 10,000 beds is available for activation within one week. The financing of the German hospital system is based on two pillars: the Federal States are bound to bear At present, it can be stated that after an initial mild the investments into the infrastructure, such as new wave in spring 2020, Germany met a severe peak in construction or refurbishment of buildings, as well the second wave in January 2021 with approximately as the purchase of medical equipment. The health 5,800 ICU beds occupied by Covid-19 patients. insurance funds pay for the costs of the treatment The third wave came with a peak of 5,000 COVID- by applying the G-DRG system (German Diagnosis occupied ICU beds at the end of April 2021. Despite Related Groups). The G-DRG system was created in the heavy workload, German hospitals were able to 1998 by modifying an Australian model and has been adequately care for all COVID-19 patients at all times. implemented in practice since 2004. It replaces the Isolated regional shortfalls have been absorbed by former system of per-diem charges by introducing a neighbouring hospital facilities. flat fee payment system. Currently, hospitals are increasingly able to return GERMANY’S COVID-19 RESPONSE to standard care and, for example, make up for postponed operations. Nevertheless, the down-scaling When Covid-19 reached Europe at the beginning of of activities and the enlargement of the capacities 2020, Germany aligned with a general two-sided resulted in important financial losses for the hospitals. strategy: On the one hand, social distancing measures These were, for the most, absorbed by means of a were taken to flatten the curve and to stretch the financial rescue package for the economic stability of number of infected people over time. On the other hospitals. However, the COVID 19 pandemic revealed hand, measures were taken to prepare the healthcare that the strong focus on activity in hospital financing sector for the pandemic. is no longer appropriate if we want to strengthen our health crisis preparedness and response mechanisms. In March 2020, German hospitals started to scale down elective care procedures as a preparation for an The DKG is therefore entering into a dialog about increase in demand for intensive care and ventilation a system that reconciles the financing of activities capacities for the treatment of COVID-19 patients. This and the financing of the costs of maintaining crisis applied exclusively to treatments, the postponement capacities. Besides, in order to continue to provide of which posed no threat to health or life. In addition high-quality medical care to all patients throughout to the freeing-up of existing capacities, hospitals the country in the short, middle and long run, the DKG installed additional intensive care capacities. Before is calling for funds for hospital digitisation, as one of the crisis, there were around 28,000 intensive care the major future challenges in Germany. unit (ICU) beds in Germany, of which 22,000 were
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“INVESTING IN HEALTH HAS NEVER BEEN SO IMPORTANT.”
By Felipe Nabuco [email protected] “It is at a time like this, of global crisis, that we see the importance of a robust and widespread hospital network The pandemic leaves valuable lessons for humanity to serve a country of continental and one of them, if not the most important, is that we dimensions like Brazil.” need to take more care of what we consider the most essential good for living: health. This care, however, needs to go beyond the individual plan and be placed as a priority in the construction of public policies. For senator Izalci Lucas (PSDB/DF), the pain and overcoming this difficult moment need to be reversed in strategic investments to qualify the Brazilian health system. “It is at a time like this, of global crisis, that we see the importance of a robust and widespread hospital Credit:: William Sant’Ana. Credit:: network to serve a country of continental dimensions like Brazil. If there is an important learning experience in this pandemic, it is that investing in health has never been so important”, he highlights.
In this interview given to Visão Hospitalar, the senator talks about the crisis scenario that affects small and medium-sized hospitals across Brazil, as well as important issues that are being discussed in the National Congress, such as the liberation of medical cannabis and the Tax Reform. “I am very concerned about making the national tax system more efficient, in the sense of delivering better services to the population and, at the same time, exempting companies”.
Author of the project that creates the Parliamentary Front of the National Congress of Foreign Investment for Brazil (Frente InvestBrasil), Izalci also discusses his proposals for the country's economic recovery, and one of them is directly linked to the encouragement of international capital. “The Parliamentary Fronts have effectively contributed to the articulation around themes of common interest. Our proposal aims to attract international investments for the country's SENATOR IZALCI LUCAS (PSDB/DF) infrastructure and development. The Brazil Institute
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of Investments and International Cooperation, VISÃO HOSPITALAR – Another issue that has been InvestBrasil Institute, was created to structure civil treated with considerable concern by entities society, embassies and countries with an interest in representing the Health Sector is related to the investing in Brazil”. Read the full interview below. Tax Reform. Previous studies point to the risks in Supplementary Health with the increase in taxes in the VISÃO HOSPITALAR – Private hospitals, especially sector, and one of them is the massive flight of people small and medium ones (with up to 100 beds), have with health plans. How do you assess the scenario? Is expressed concern about the difficulties in adapting the debate a priority now? Why is that? to the new requirements of the GDPR - General Data Protection Regulation (In Portuguese, Lei Geral de Senator Izalci Lucas – Without a doubt, the current tax Proteção de Dados - LGPD). Most claim financial model is outdated. It is necessary to find a new one difficulties to invest in technology and training. As a that meets the needs of the moment, guaranteeing the full member of the Committee on Science, Technology survival of the private sector, without neglecting the and Innovation (CCT), in the Federal Senate, how have sources of revenue that make the public sector work, you been following this debate? regulating economy sectors and providing assistance in times of crisis such as now. I am very concerned about Senator Izalci Lucas – The GDPR brought important making the national tax system more efficient, in the advances towards data protection, in a world where sense of delivering better services to the population the internet spreads information almost without rules and, at the same time, exempting companies. People and globally. It was necessary to start establishing want more jobs, not more taxes. The tax burden has a legal regulation, which began with the Marco Civil reached its limit in the current model. The problem da Internet and which has an important stage in the is to make the reform that meets all spheres: federal GDPR. Many sectors are claiming difficulties. Perhaps government, states, municipalities, taxpayers and the government can think of some incentive or benefit companies. This is the big challenge. So it's hard to to small hospitals. Any initiative in this regard will have build a consensus, but I'm optimistic. Let's get there! my support. VISÃO HOSPITALAR – In your opinion, what is needed VISÃO HOSPITALAR – In April, the Brazilian Hospital for the country to recover its economic vitality, severely Federation (FBH) and the National Health Confederation shaken by the pandemic? What should be the priorities, (CNSaúde) published another updated edition of especially on the part of the Executive and Legislative? the “Scenario of Hospitals in Brazil 2020”. The study showed that the country lost, between the years 2010 Senator Izalci Lucas – This is a different crisis and 2020, about 600 hospitals and 40.000 beds in the from the others. We need a buffer to deal with the private network, as a result of the financial crisis that economic shock and its consequences. Adopt a devastated the sector. How do you see the problem? more comprehensive social protection model that Why has the country suffered from this scenario? includes informal workers; a basic income program that expands and goes beyond Bolsa Família. The Senator Izalci Lucas – These numbers certainly refer government should create a program to support the to the pre-Covid pandemic phase. It is at a time like restoration of restaurants, services and hotels, among this, of global crisis, that we see the importance of a others. It would be positive to create a more flexible robust and widespread hospital network to serve a credit line for small and medium-sized companies. It country of continental dimensions like Brazil. If there is could be used for payroll and the money would be an important learning experience in this pandemic, it is tied to each company's income. Make the economy that it has never been so important to invest in Health, work, secure jobs and stimulate consumption. It is also in the Unified Health System (SUS), which proved to be necessary to close the drains of corruption and misuse efficient and fundamental in combating the disease. of public money. In the pandemic, there were signs of The private sector, which has complemented the SUS, irregularities and operations by the Federal Police in is also acting in a relevant way. In other words, the the area of health. And look, there were more people two systems are complementary and fundamental. dying because of it. See in the Federal District, three I think the pandemic showed the need for strategic Federal Police operations and the prison health dome. investment in health and will strengthen the sector. Didn't the governor know anything? Where were the
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supervisory bodies subordinate to him? How to spend believe that the Senate should promote a broad debate less and better if there is corruption? I think that, in before taking a position. Medical professional entities part, this has to be resolved in the voting machine. need to manifest themselves openly on the subject. People need to choose their representatives well. Academic entities need to have a position. Now, this debate cannot be confused with the issue of drug VISÃO HOSPITALAR – You recently presented a addiction and drug trafficking. See the advance of drug suggestion for the Ministry of Tourism to implement trafficking and militia across the country. This position the “Vale-Turismo” (Tourism Voucher) as a way to of mine is related to the controversy that dominated stimulate activity and promote the recovery of the the United States for a decade. In recent years, several economy across the country. How would this proposal states have legalized the medicinal use of Cannabis work? What are its impacts on the economic growth of sativa. Today, medicinal use can be done, by law, in 38 Brazilian municipalities? of the 50 American states. Of these, in 16 of them adult Senator Izalci Lucas – A "Voucher" within the scope use is also allowed. It's not an easy topic. It is necessary of a tourism program to guarantee, encourage and to build a consensus. expand access to citizens, was the proposal I sent to VISÃO HOSPITALAR – You are the author of the project the Ministry. The sector is one of the most affected that creates the Parliamentary Front of the National by the coronavirus pandemic and, therefore, it needs Congress of Foreign Investment for Brazil (Frente stimulation. The Getúlio Vargas Foundation points out InvestBrasil). What is the role of this new Front and how that tourism, in 2019, represented 3.71% of GDP. But should it act? now, according to the projections of the same study, the impact of the pandemic is expected to cause a loss Senator Izalci Lucas – The Parliamentary Fronts have of R$ 116.7 billion, in the biennium 2020-2021. This effectively contributed to the articulation around represents a loss of 21.5% of projected. In addition, themes of common interest. Our proposal aims to an IBGE survey indicated that, in 78% of Brazilian attract international investments for the country's households, no resident traveled in 2019, and 50% of infrastructure and development. The Brazil Institute of them were due to lack of resources. As can be seen, Investments and International Cooperation, InvestBrasil there is a need for the public authorities to intervene. Institute, was created to structure civil society, Without this, there will be no resumption of the sector. embassies and countries with an interest in investing There is a large demand from the population, but this in Brazil. InvestBrasil seeks to promote economic, possibility is deprived exclusively due to the scarcity of social and sustainable development in all states, as financial resources. It is necessary to look for incentives. well as integrated actions in the areas of infrastructure, Brazil has wonderful potential. The "Vale-Turismo", the projects, social actions, economic and strategic voucher, would promote the dynamism of tourism. planning. Our goal is to seek foreign resources, creating a business environment, institutional articulation and VISÃO HOSPITALAR – The Special Committee of the public management. And these foreign investments Chamber of Deputies gave a favorable opinion, on June and international resources need some actions by the 8, to Bill 399/2015, which authorizes the cultivation, in Legislative Power, structured projects and frequent Brazil, exclusively for medicinal, veterinary, scientific studies on investment themes that Brazil needs. For this and industrial purposes, of Cannabis sativa. Now, the reason, we created, with the support of all parties, the discussion goes to the Federal Senate. What is your Parliamentary Front in Support of Foreign Investment, position on the topic? Why is that? the InvestBrasil Front. Senator Izalci Lucas – This is a subject that deserves a great debate with society. There is a lot of confusion and prejudice that get in the way of this issue. We are in the age of fake news, when medicinal use can be confused with recreational use. If medicine recognizes cannabis as an instrument for medicinal purposes, we do have “Our proposal aims to attract international to discuss its use and commercialization, but with all investments for the country's infrastructure the control and monitoring of the State. Therefore, I and development.”
| 17 REFERENCE HOSPITAL
PHILANTHROPIC INSTITUTION IS A NATIONAL REFERENCE IN SURGERIES PERFORMED ON BABIES BEFORE BIRTH
Central nervous system anomalies and heart disease are examples of diagnoses that may require intrauterine intervention during pregnancy. HCor's fetal medicine service makes highly complex procedures available to patients in the public health system
Cases of babies with malformations can cause serious "In cases of critical aortic valve stenosis, which is developmental sequelae and even increase infant an example of heart disease, we introduce a needle mortality. It is estimated that about 2% to 3% of newborns into the mother's womb in order to reach the clogged have one or more congenital malformations, which are baby's heart valve, reestablishing blood flow allowing responsible for 20% of neonatal mortality and 30% to for a healthier birth condition", details Peralta. 50% of perinatal mortality in developed countries. The surgeon also highlights that, in cases of FFTS, According to Fábio Peralta, fetal surgeon at Hospital do the team can originate by a laser removal treatment, Coração (HCor), performing prenatal tests helps in the endoscopically, interrupting the blood exchange diagnosis of different diseases and changes in fetal between the fetuses, in order to stop the imbalance well-being, which can significantly change the outcome in the blood flow between the two babies, minimizing of pregnancy. "With the correct diagnosis during the risk of death and neurological sequelae. pregnancy, the doctor can suggest intrauterine (prenatal) interventions, which improve the chances of survival and Intrauterine procedures also demonstrate benefits the quality of life of affected patients", he explains. in cases of myelomeningocele, since with them it is possible to correct spinal malformations and Among the conditions that often require intrauterine guarantee more chances for the patient to walk without surgery are heart disease, which can affect one in every assistance and have better intellectual development. 100 pregnancies; fetal myelomeningocele (open spine bifida), with an incidence in one in every 1.000 newborns CARE FOR PATIENTS IN THE in Brazil; and the feto-fetal transfusion syndrome (FFTS), PUBLIC NETWORK which occurs in 10% to 15% of monochorionic twin pregnancies (two fetuses sharing the same placenta). With an obstetric team specialized in high-risk pregnancies and a team specialized in fetal medicine,
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Since 2009, the unit offers According to the scope of the project, babies with diagnosis of fetal myelomeningocele or FFTS can be intrauterine surgeries for mothers assisted. Altogether, more than 250 highly complex who have their prenatal care in the treatments have been granted over these years. public network. The Intrauterine The cases are referred to the hospital by the network Surgery project is carried out of medical contacts throughout Brazil and receive outpatient care, with tests being carried out before through the Support Program for and after the surgical intervention.
Institutional Development of the "Our goal is to promote the improvement of the quality Unified Health System (Proadi-SUS). of life and survival of these patients, reducing the sequelae and reducing the infant mortality rates of this population served by the SUS", explains Bernadette Weber, superintendent of Social Responsibility at the institution.
The HCor also started to include pregnant women with these clinical conditions in its free program, carried out by the Syrian Beneficent Association, which maintains the hospital. In this new philanthropic project, pregnant women assisted through the project FOTO Hcor developed by Proadi-sus receive the same standard of assistance.
"Intrauterine surgeries are highly complex and require expertise from the entire health team involved. Therefore, we want to put our team on the field to provide these families with better quality of life and better prognosis for Brazilian children", emphasizes Bernadette.
ABOUT HCOR
HCor stands out as a national reference in this area HCor is a philanthropic institution that started its and has the most modern therapeutic techniques for activities in 1976, having as sponsor the centenary the treatment of anomalies of all kinds that occur and Syria Beneficent Association. It offers services in more are diagnosed in fetal life. than 50 specialties, including Neurology, Oncology, Orthopedics and Cardiology – an area in which it has Since 2009, the unit offers intrauterine surgeries for great national and international reputation –, it also has mothers who have their prenatal care in the public its own diagnostic medicine center. The hospital has network. The Intrauterine Surgery project is carried several accreditations, including the Joint Commission out through the Support Program for Institutional International (JCI), and has been a partner of the Development of the Unified Health System (Proadi-SUS). Ministry of Health in Proadi-SUS for over ten years.
| 19 PROJECT MANAGEMENT BETWEEN SAILS AND PROJECTS "Navigating is necessary, living is not necessary" (Fernando Pessoa)
Leaving aside the numerous interpretations given ship "company", which aims to reach an unexplored to Fernando Pessoa's phrase, we traced our own land called "market". For this purpose, we will call the analysis under the organizational strategic outline of propeller sail of this ship a “project”, and this sail must the post-pandemic 21st century. We are talking here be cared for, very well cared for, and, mainly, pointed about our organizational navigation, in which the in the right direction, otherwise we will fail in our captain "manager" is responsible for conducting his mission.
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Sails are to ships what projects are to organizations. PROJECTS OPERATIONALIZE THE Unfortunately, we often see a gap in understanding ORGANIZATIONAL STRATEGY the impact caused by a technically and responsibly carried out project management and its achievement Having a great idea or even being a great strategist in terms of organizational strategic objectives. For this is not enough when there are operational failures. reason, we commonly face some situations: There is a huge gap between the designed strategy and its actual operationalization, and this gap can Situation 1 (and should) be reduced through professional and responsible project management. The organization is either aware of the existence or has minimal knowledge of appropriate techniques It's time to rethink, act in favor of your organization, and approaches to manage and conduct health turn ideas into results, ensure deliveries on time, with projects and it acts in a disorganized way, burning the expected cost and quality, and make sense of resources and money, leading to frequent delays in ongoing projects. deliveries and often overspending. It's like being on We must understand that, before blindly advocating our ship with the sails down and using oars to reach for adopting an Agile, Waterfall or even a hybrid the unexplored land. approach, we need to know the characteristics of our projects and know when, where and why to apply each ●Situation 2 approach or each tool. Why adopt Scrum or Kanban? The organization knows how to identify the most Do predictive approaches work? PMI or Prince2? appropriate approaches for its projects, as well as Anyway, managing projects is more than a science; it using some techniques for compliance (sometimes, is also an art. even reducing deadlines and costs in ongoing The journey is long and full of challenges. Therefore, projects), but it still cannot exploit its full potential. It's we need to have on our ship competent specialists in like handling the sails of our ship without knowing the the handling of sails. best way to exploit the good winds or even directing them to an unwanted route. If navigating is necessary, let's make efficient and professional navigation, because only in this way can ●Situation 3 organizational life coexist with the act of navigating! The organization knows and applies project Have a good trip! management. Now, it needs to be improved and adapted to new techniques and existing technologies in order to increase its efficiency. It is the same as It's time to rethink, act in favor of your adapting engines to propulsion in our ship with organization, turn ideas into results, ensure sails. As in the two previous situations, caution and deliveries on time, with the expected cost and knowledge are needed at this time of transition, as quality, and make sense of ongoing projects. our ship will need adjustments to adapt to this “new” propulsion method.
Let's go a little deeper: what is the reason for knowing RODRIGO ALMEIDA RODRIGUES how to operationalize and manage projects in a Engineer. Internationally certified PMP (Project technical and responsible manner? Management Professional), with an MBA in Project Management from USP. Black Belt Lean Six Sigma. Master's student in Strategy at the University of Lisbon. Project Consultant at Andrea Prestes Institute (API).
| 21 HOSPITAL NETWORK
THE EFFECTS OF THE PANDEMIC ON THE MANAGEMENT OF SERVICE PROVIDERS
There have been countless challenges faced by the Brazilian hospital network, as well as the entire health sector, since the first case of Covid-19 arrived in Brazil. Adversities have been chained together and, with each overcoming, a new problem seems to arise to challenge administrators, technicians and professionals from all areas of hospital management. For establishments that are at the forefront of the fight against the pandemic, among them thousands of service providers, this effort to overcome this has been monumental, especially given the conditions they were in even before Covid-19 arrived here.
In Brazil, of the 4.200 hospitals currently in the private network, almost half, or 45%, are made up of establishments that provide care under the Unified Health System (SUS). In other words, there are more than 2.000 private hospitals performing services as service providers by the public system in the most diverse regions of this immense country. In many cities, they are the only medium and high complexity assistance option for millions of Brazilians.
The adversities that these establishments have been facing can be listed in temporal order. Right from the start, in March, April, May and June 2020, the first challenge faced by all establishments, including those not on the front lines of the fight against Covid, was the scarcity
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of inputs, as Personal Protective Equipment (PPE), necessary updating of the amounts paid by the SUS especially masks and gloves; 70% alcohol; in addition Table for procedures in the hospital network. These to medications. This scarcity led to an exorbitant values are very outdated and make investments in price increase, severely impacting the finances of modernization and expansion of services offered to the establishments, which were no longer doing well. population unfeasible.
In a second moment, the adversities focused on the There is also a need for the federal government to general shortage of beds and respirators; in the lack implement measures that encourage the financial of specialists, especially outside the Southeast region; recovery of these establishments, such as the creation and, more recently, the lack of intubation kits for the of special credit lines. FBH has also been stimulating Intensive Care Unit (ICU) on the market. It is important the debate on public-private partnerships in the SUS. to highlight that the issue of shortage of professionals As, in 2020, there were more than 1 million procedures specialized in Intensive Care was found in almost the damned, for 2021 and 2022 the expectation is of huge entire country. The problem is not just being able queues that will need to be cleared, and, for that, it will to open a new bed: there was a lack of specialists to be necessary to have more establishments and more provide care in these beds. This is a deficiency that the health professionals available. It will be necessary to country urgently needs to repair. think of strategies to ensure that millions of Brazilians who are no longer followed up during the pandemic According to the Scenario of Hospitals in Brazil 2020, can resume their treatments. For this, we believe that a a study that the Brazilian Hospital Federation (FBH) partnership between the public and private sectors can updates annually, Brazil lost 600 hospitals and about provide a suitable answer. 40.000 beds from the private network in the last decade (2010-2020). You see, this means that, even Therefore, our expectations are in the implementation before the pandemic, the Brazilian hospital sector was of policies and actions that help hospitals that are in already dying. Problems that are historic only got worse a situation of financial crisis to recover, and thus be with Covid-19. able to maintain essential services for the population, in addition to safeguarding thousands of direct and Importantly, not all hospitals were at the forefront of indirect jobs. Today, around 70% of the Brazilian fighting the pandemic. When elective procedures were hospital network is made up of small and medium- suspended by the National Agency for Supplementary sized hospitals (with up to 100 beds), which amounts to Health (ANS), as a preventive measure, what was seen approximately 3.000 establishments. They are essential was the emptying of offices. Many of these hospitals hospitals for the functioning and sustainability of the became idle and even lost about 40% of their Brazilian health system, since 45% of all existing revenues. Still others are at risk of closing if urgent hospitals, that is, almost half, provide care through bailout measures are not taken. SUS throughout Brazil, as service providers. Out of ten of these hospitals, seven are located in cities outside FBH, as a pioneer entity in the representation of the capitals. As I mentioned earlier, in thousands of Brazilian hospitals, has been leading, alongside municipalities, they are the only option for hospital care partner institutions, claims that are historic and that, for the population. at this moment, require special attention. The first one concerns the necessary adaptation of the national tax policy. Today, Brazilian hospitals are impacted by a high tax burden. Another urgent agenda concerns the LUIZ FERNANDO C. SILVA Superintendent of the Brazilian Hospital Federation (FBH).
| 23 24 | AHEG VISÃO HOSPITALAR MAGAZINE
STRONG REPRESENTATION OF GOIÁS TO THE WORLD
In August of this year, the Association of Hospitals of the State of Goiás (AHEG) celebrated 53 years of representation. We are proud to be the oldest and largest association of healthcare facilities in our state. Today, there are about 300 members in almost all 246 municipalities of Goiás. Since 1968, when the trajectory of challenges, struggles, overcoming, dedication and achievements began, AHEG has established itself as a vanguard entity, enabling milestones for the universe with which it dialogues so well: that of health establishments.
Understanding the anxieties and daily difficulties of hospital managers, as the association is made by managers for managers, has enabled us to articulate actions that permeate the public and private spheres in favor of constant improvements aimed at a final beneficiary: our patient.
Correcting tax injustices and many others is one of the objectives of our work. Intrinsic to our essence is the collective and, therefore, the work developed by the association unfolds into benefits that serve the collectives we call society. We do not only see our universe, but we see it as a tool that is bigger than us, which expresses the values needed to build a better society for all of us.
Thus, along this journey, we understand that AHEG has been a faithful ally of the health sector. From the inside out, the association acts as a safe haven, a foundation through its departments – Pharmacy, Qualification, SCIRAS, Relationship with the Associate, Relationship with the Interior Associate, Legal and Communication -, which develop actions focused on
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the development, improvement, qualification, defense International Hospital Federation (IHF) is an important and dissemination of important information for the articulator of measures that excel in health promotion, manager and health establishments as a whole. These the exchange of experiences and information are projects and actions that have made a difference between nations and strategic decision-making for and have even been raised as a reference for the the Health Sector. We are there! It is the state of entire country. Goiás participating, through AHEG, in the actions and projects that will take effect around the world. Thus, The dedication focused on internal work is the same we are actively present in discussions about what the when the task is one of articulation with the public world has to offer that is most advanced and urgent in sphere. Debating, suggesting or contesting bills, for discussions that concern associations and the health example, are part of this daily office of the AHEG business in general. Board of Directors. In fact, this is an arduous mission in the current Brazilian and world context in which we AHEG is proud to be the first, largest and main find ourselves. But we never measured efforts and, association in representation of our state. Many more therefore, we have reached unprecedented spaces for years to come! The fight is always hard, but we are the representation of our state. Today, the Brazilian prepared. Congratulations, employees and associates! Hospital Federation (FBH), this important body for our You are the ones who make our history. sector, has a president from Goiás. It is AHEG that, in the figure of its president, is represented there. ADELVÂNIO FRANCISCO MORATO But we are no longer just on the national level. President of the Association of Hospitals The president of our association is also part of an of the State of Goiás (AHEG) and of the Brazilian Hospital Federation (FBH). international federation, founded in 1929 and which brings together more than 30 countries. The
AHEG is actively present in discussions about what the world has to offer that is most advanced and urgent in discussions that concern associations and the health business in general.
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BIOXXI INVESTE OFFERS FINANCIAL SUPPORT TO HOSPITALS THAT ADOPT THE BIOXXI CME MANAGEMENT MODEL
By Amanda Vasconcelos [email protected]
The fund, created by the largest CME Management Model, with a view to investing in selected establishments. company in Latin America in the sterilization of health products, aims Through this program, hospitals will receive a personalized financial contribution from Bioxxi that to help hospitals in this moment of will correspond to the size of the CME structure and crisis aggravated by the pandemic the number of procedures performed per month.
For Maurício Essvein Fogaça, executive director of The hospital sector, which has always been in constant Hospital Nossa Senhora de Fátima, located in Curitiba transformation, is facing, since 2020, one of the and which focuses on women's health at all stages greatest challenges in overcoming the economic of life, the partnership with Bioxxi provided the impacts caused by the crisis generated by the new establishment with a more modern and professional coronavirus pandemic. management process, with main focus on the patient. “Throughout these years of management, I've learned The significant increase in the price of supplies, the that the main strategy of a hospital or health manager closing of surgical centers and the drastic decrease in is to always put the patient first. Planning all other elective procedures affected many hospitals in Brazil, resources based on the patient's needs makes us resulting in the closure of a large part of those who more assertive. Here at the hospital, all support areas were unable to survive this scenario. are outsourced; thus, we were able to focus on the core activity, which is motherhood, and it is more Realizing the scale of the crisis and the impact it had advantageous for us to have competent partners to on the Health Sector, Bioxxi, the largest company in develop the other stages of the process”. Brazil specialized in the management of a Materials and Sterilization Center (In Portuguese, Centro de Bioxxi's model brings predictability of expenses, Materiais e Esterilização - CME), created Bioxxi Investe, gains in efficiency and safety. Fogaça, who is also a a fund aimed at partner hospitals that adopt the Bioxxi professor of hospital costs and strategic planning, says
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that it is necessary to look at now and project a chart of things, for example, how to control fixed costs and Benefits guaranteed by have a margin from variable cost through revenue. outsourcing CME management “If I have the possibility of improving a result for a hospital and a third party gives it to me, there is no • Increased sterilization capacity and sector reason to have the labor risk and all the other costs productivity; involved. There are several benefits: we don't need to invest in technology, which is the responsibility • More agility in reprocessing time; of the outsourced company; staff training is also the responsibility of the third party; and another very • Reduction in surgery delays and hospital important aspect is that these agreements are by infection rates; service level, with the variability of people not being • Implementation of state-of-the-art my responsibility”, he concludes. technology, with the CMEXX system;
• Control of indicators, reporting and support Bioxxi's model brings for accreditation; • Compliance with standards such as RDC 15; predictability of • Full traceability of all materials;
• 150% increase in productivity of CME expenses, gains in employees. efficiency and safety.
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| 29 PEOPLE MANAGEMENT
THE IMPORTANCE OF MUTUAL INTEGRATION AND COLLABORATION IN THE DEVELOPMENT OF PEOPLE IN THE HEALTH AREA
I usually say that people management is a bigger concerned only with its responsibilities and had a challenge when it comes to the health sector. Also “vertical” and hierarchical view of the organization, taking into account the pandemic scenario, it is no but things changed substantially. exaggeration to perceive its complexity. There are several business areas, each represented by its entities The integration of sectors is important in terms of the and unions. However, there is still a greater challenge: ability of decision makers to collaborate with each the integration of these areas. other. When departmental managers are able to work in coordination with each other, they find it easier to When that doesn't happen, it is inevitable that losses implement more effective action plans and promote start to appear: lack of dialogue between teams, an integrated culture to their team members. mistakes and rework, conflicts and lack of cooperation are some of the effects. We live in a world of cooperation Furthermore, if the sectors do not dialogue, they lose and mutual collaboration and, in times of crisis, this is synergy, they do not add value to the service process even more pronounced. We need to understand how for the final customer: the patient. And, of course, they integrated management can be very beneficial. miss the chance to learn integration, which is only possible through interaction and multidisciplinarity. Promoting sector integration is a challenging investment. The return comes in the form of This is because professionals with varied specialties, engagement and good working relationships and such as physiotherapy, nutrition, nursing, IT, clinical reflects on the growth of the organization as a whole, as well as on the cutting edge, in delivering value- based healthcare. TANIA MACHADO President of HUHRH+ABPPRH, CEO of TM Jobs In the past, it was common for each department to be and founder of Business Club Healthcare and seen in isolation, following a Cartesian model applied Valor em Saúde channel. Member of Inlags to companies. In other words, each department was Academy and Somos 60mais.
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engineering and administrative and care areas, have Achieving organizational integration involves aligning experience in different areas. Each one can contribute strategy, culture, team skills, technology, structure and with different knowledge, meeting the institution's management style with the macro business objectives. strategic and practical needs much more directly. This includes making sure that every department and every employee understands the importance of this. It Creating continuous improvement groups and using also involves educating stakeholders. the full power of communication allows not only to improve the transmission of information, but also to Finally, it is important to point out that this integration facilitate approximation and optimize processes. After only happens after a change in the attitude of the high all, if employees are well informed, they are also more hierarchy of the business and, also, of department engaged and capable of developing good operating leaders. The creation of a culture of sector integration strategies. must come from the top down. It can – and should – involve all employees in the business, but it is up to But if it's important to integrate the work, why not the management to take the lead so that resistance to carry out a multi-stakeholder performance review? change is lessened. What cannot be measured cannot be improved! Composite performance indicators (also called KPIs, or After all, as Augusto Cury says: "The greatest leader is key Performance Indicators) involve various types of the one who recognizes his smallness, draws strength measurements to show how people and the company from his humility and experience from his fragility." are doing. By betting on KPIs that involve variables from multiple departments, the institution is able to Promoting sector integration is a challenging build a broader analysis. With this, it is possible to investment. The return comes in the form of have a more global vision and work from a perspective engagement and good working relationships and in which everyone is engaged, taking responsibility reflects on the growth of the organization as a whole, and looking for collaborative solutions. as well as on the cutting edge, in delivering value- based healthcare. It is true that professionals may initially be somewhat resistant to a culture of dialogue between the various areas. Dealing with people is not a simple task. But it is these diversities that allow for the enrichment of work, the formation of more constructive strategies and more integrated proposals.
| 31 INTERNACIONAL
THE JOURNEY OF COVID-19 VACCINE IN HONG KONG
The first shipment of 585,000 doses of Fosun Pharma For the temperature sensitive Comirnaty vaccine, they BioNTech COVID-19 vaccine (Comirnaty) arrived were packed in dry ice in thermal boxes designed to in Hong Kong (and earlier the Sinovac COVID-19 keep the vials at below -70 °C, which is colder than vaccine) on 27 February 2021, about a year after the Antarctica in winter. coronavirus pandemic began in the city. DCH Auriga, an Asian-based integrated market management “The thermal boxes are equipped with data loggers provider specialising in healthcare, has since been that monitor the temperature from source to final assigned the important task to ensure the safe and warehouse destination to watch that the vaccine is efficient storage and distribution of both vaccines. kept at ultra-low temperature.”
David Mouland, Vice President Logistics of DCH “Once the shipment is unloaded at our storage facility, Auriga, said they are in charge of the end-to-end the boxes are weighed then unpacked with photo and validated supply chain from collecting the product video record taken and the vaccine is transferred to from the airport, receiving at the DC, storage, pick- the specialized ultra-low temperature refrigerators. and-pack, repacking, labeling, to local deliveries. Such actions are to be done strictly within 3 minutes DCH Auriga have made very detailed preparations to 30 seconds, and we use a stopwatch to monitor and store and transport the vaccines in full accordance remind our staff all through the put-away process.” with the requirements set by the drug manufacturers and the Government. THAW AND REPACKAGE BEFORE USE
FREEZING CHALLENGE Before the deep-frozen Comirnaty vaccine is AT 3MIN 30SEC delivered to a vaccination centre or an outpatient clinic, it has to be thawed for 3 hours. “The “Upon the arrival of the vaccine, our staff carry out vaccination centre facilities will keep the product in stringent checking and inspection of the vaccine a 2°C-8°C refrigerator, and due to the short shelf life to ensure that it complies with the regulations of the product at this temperature, we must have the and the cold chain integrity throughout the whole vaccination schedule and the number of vaccines transportation process. needed at each facility beforehand so that we can deliver the exact quantity to be used each day. We
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Vaccine identification would then add the unique GS1 2D barcode label (GS1 Datamatrix) during repacking, and pick each information, such as GS1 order of vaccine after thawing in a 2 - 8°C cold room barcodes, is essential for before the delivery.” healthcare supply chain “Vaccine identification information like GS1 barcodes is essential for healthcare supply chain stakeholders to uniquely stakeholders to uniquely identify and track-and-trace identify and track each each jab, from delivery to point of administration. I believe GS1 standards bring transparency and help injection, from delivery to the to improve supply chain coordination, decreasing the risk of vaccine diversion, date expiration and fake point of administration. vaccines proliferation.”
Embracing GS1 standards adds an element of trust at all levels of the supply chain—a trust that ultimately extends to the patients themselves.
GS1 standards bring transparency and help improve supply chain coordination, ANNA LIN decreasing the risk of vaccine Chief Executive, GS1 Hong Kong diversion, expiration date and proliferation of fake vaccines.
| 33 INNOVATION
THE IMPORTANCE OF OCCUPATIONAL MEDICINE
Occupational Medicine has been growing within DENIS PINEDA companies for a long time. Occupational Medicine, Regional manager of Universal Robots in Latin America, a leading Danish which is extremely important for all sectors, was company in the production of industrial implemented after the State established rules for all collaborative robot arms. companies, in order to guarantee the well-being and protection of employees, as well as offering them more physical and psychological integrity. Therefore, its main objective is to prevent accidents and occupational diseases, and it is also committed to the to be exposed to actions in this category, because, quality and maintenance of workers' health, ensuring regardless of the reason, 60% of employees, upon that the activities carried out on a daily basis do not leaving the company, file suits in this regard. pose any risk. Among the benefits of this implementation and Today, one can no longer imagine a corporation without obligation is ergonomics, the foundation responsible a specialized doctor, who is exclusively dedicated for developing measures to reduce possible risks, in to the prevention and treatment of all diseases the corporate environment, within the physical space involved in the organization's professional activities. and even in the organization of processes. In addition The Consolidation of Labor Laws (In Portuguese, to this, others such as increased productivity, reduction Consolidação das Leis do Trabalho - CLT), in its art. 168, of leaves and expenses with staff turnover, prevention ensures the obligation for the employer to submit all of occupational diseases, improvement in corporate employees to pre-employment and dismissal exams image and reduction of financial losses are also seen. and another one focused on periodically evaluating their health evolution. Therefore, all sectors are Thus, it is clear that companies that invest and really subject to this rule and must apply the measures care about the well-being of their employees stand provided for in the Regulatory Norms (RNs) of the out. But regardless of this, all the rules already in place Ministry of Labor and Employment, especially if there and frequent monitoring do not exclude the fact that are employees over 50 years old in areas considered employees get sick, as age is also a determining factor to be risky. for this. Making sure they have doctors and guardians accompanying the entire process is essential to ensure With a well-structured service within the companies, that everything works as per the established rules. the occurrence of labor claims is minimized, as accidents are avoided and people feel well supported Thus, I conclude that Occupational Medicine will if something happens. In any case, it is important to always be essential for companies, especially to emphasize that it is already part of Brazilian culture maintain a humanized commercial establishment. In
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industry, for example, it is necessary to create pleasant, problem like this can cause, as it can be much higher safe and comfortable places so that everyone is in an than the investment in robotization, for example. Not ideal environment. In addition, the implementation of to mention that many of the professionals who return robots has been solving several common problems after an injury need to be relocated to new compatible and working to help problems caused by lack of roles and a new employee will need to be hired to fill optimization. It is also worth taking into account the the position. Think about it! cost of temporary or even permanent leave that a
The implementation of robots has been solving several common problems and working to help problems caused by lack of optimization.
| 35 PERSONAL MANAGEMENT
The challenge for the healthcare leader in Brazil is to understand LEADING and adapt institutions to the growing demands for care, with attention to the triple burden of IN TIMES disease; the growing incorporation of technologies; and, above all, the scarcity of resources, especially in OF CRISIS times of pandemic. Credit: Dante Garcia Credit: Credit: Dante Garcia Credit:
Have you ever reflected on the difference between is eminently a human action, carried out with many “dealing” and “leading”? How not to talk about humans. Health care mobilizes more than 70% of something as essential and impactful for the result of HR resources – professionals from different areas health organizations as the “act of influencing people and backgrounds. With the exception of inputs and and achieving common goals”? Positively impacting manufactured materials, most health deliveries are employees and managers in a complex and relevant intangible, promoted by human beings. The Health sector such as healthcare is a challenge, especially if Sector “starts and ends” human life with the support we think about crisis contexts and scenarios. Fatally, of organizations (hospitals) made up of many people, we will force ourselves to rethink, create and innovate in different professions, mobilized 24 hours a day in strategies and positions in the difficult art of dealing positions and functions. with people. With regard to the diverse and varied crises and I have a quote that reinforces this thought: people changes experienced in the last decade, increasingly temper with people. In this context, I invite you to disruptive scenarios are inaugurated. The challenge some reflections. Initially, we reinforced that the for the healthcare leader in Brazil is to understand and production and delivery of added value to the patient adapt institutions to the growing demands for care, with
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attention to the triple burden of disease; the growing 4. If the leader does not influence his collaborators incorporation of technologies; and, above all, the as a teacher, he will take the risk of others teaching scarcity of resources, especially in times of pandemic. them what would not be essential to the purpose of the work; We reinforce that, in the next 30 years, relevant impacts will be experienced in our sector, consequences of the 5. Leadership must prioritize executing the strategy. merger of biotechnology with information technology. As Maxwell said, “Ninety-nine percent of all Radical and singular changes will be opening up leadership does not happen at the top, but at the spaces. The internet of things and the volume of social middle echelon of an organization, that is, at the connections will require people to be prepared to lead in tactical or managerial level”; this context. The forms of work and business relationships will be subject to results in geometric dimensions. 6. The leader must increase the cultural transformation, promoting expanded listening The evolution of non-biological species, robots, will forums, innovation labs, gamification aimed at promote more efficiency to processes, more repair the dissemination of values, development and capacity and less susceptibility to errors. This will training of people and viral solutions; require a more entrepreneurial educational process and will have to take place at very different standards 7. The leader must promote empathy and happiness; from nowadays. The centenary rites will give way to a transformation, with new forms of work. You will need 8. Leaders need to know/want to have the difficult to learn in a variety of ways, including outside of school. conversations: address issues early; ending the fear of informing (our culture is still one of Leadership in these contexts will require changes in friendship, of camaraderie); knowing how to give the competency management paradigm. Given the good and bad news; feedback must cross the well-known concept of "generational conflict", we barrier of non-acceptance; realize that the digital natives of Generation Z will demand new forms of relationship, communication 9. The leader of the future must establish, in and understanding of the world, and the young people his nickname, diversity, democracy, integrity, of the F5 generation (an analogy to the computer execution capacity, emotional intelligence, keyboard) will be even more different, as they adopt transformation, innovation, entrepreneurship. full time behavior (connected 24 hours), feed (fed by Finally, I return to the original question, conceptualizing: different sources), filter (select what interests them), dealing with people means “to deal with, fight”, and focus (deepens only in what interests them) and leading people means “influencing people, reaching flexibility (transit easily in any topic). goals, leading with quality, collaborating”. For all that we have brought so far, we present some Rest assured: we are leading people, we are leading characteristics and profiles that we deem essential to hospitals, we are leading health, we are leading lives! lead in the crisis: Undertake transformational leadership to achieve the 1. Leadership must convert staff into teams; extraordinary!
2. The leadership must lead the teams to become excellent problem solvers, developing logical and mathematical skills; DANTE GARCIA DE PAULA Executive, strategist and talent developer in 3. The leader must understand that his resources healthcare. Producer of the podcast channel DG – Doses de Gestão. AGIR's Management and are changeable; his speech is his practice, and to Planning Superintendent. educate is his duty;
| 37 MARKETING
HOW TO MEET THE MARKETING STRATEGY IN PHARMACEUTICAL MERCHANDISING?
Have you ever stopped to ask yourself how many At the sales point, the trade marketing strategy is a brands you know? Do you have any idea how much way of valuing products and making their market share it impacts us daily? How, then, do you make the more aggressive and relevant. We understand that the products at the sales point stand out? In this scenario, presence of a promoter, representing the brand, can the importance of having a well-prepared sales point be a decisive factor in closing the purchase. One of to receive customers and create interactions with the promoter's functions is to directly support the them can be seen. placement of items, making them often identify the opportunity for cross merchandising activations. As Analyzing the pharmaceutical segment as a case, an example, we can mention the sanitary pads next to pharmacies can be considered, nowadays, more and intimate soaps. What woman has never gone looking more as a purchase option for the shopper, not only for acetone and ended up buying a new color of nail in the search for medicines, but also for health and polish or a packet of cotton? Diaper rash ointment well-being products. Devising strategies so that such on the side of diapers is also a good example. This products are well positioned and provide a good way, when you go looking for a certain product, the shopping experience can make all the difference. chance of also buying a correlated one can increase significantly and, as a result, contribute to a sell Faced with so many product offerings, how can out increase. It is important to remember that the you differentiate yourself? They are not exposed promoter is the last person to have contact with the randomly, without any criteria. They follow an order products before the final consumer. and must be arranged by category in order to increase their visibility. Many people don't know, but behind Note that many OTCs (over the counter) drugs that this organization there is a well-trained and prepared do not need a prescription for sale, are already team to properly position each item. This strategy can outside the counter of pharmacies, according to boost sales considerably compared to establishments planograms designed to facilitate their location on that don't care about product placement. the shelves, thus reducing dependence on the clerk
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RONALDO BARBOSA Trade Marketing Consultant at Interplayers.
or pharmacist, who normally has other attributions. Have you ever noticed how many opportunities there Often, when the product is not located, the purchase are at the sales points? How can a pharmacy be ends up being abandoned. attractive to customers? Behind this attractiveness there is, behind the scenes, the work of a team that The sales promotion and merchandising team is also is often invisible, but which makes a lot of difference. very important in seasonal actions, as it can support The sales promotion and merchandising team adds the targeting of products that are the focus of the value in ways that consumers don't notice, but they season - for example, in summer, the provision of certainly appreciate it, as well as the establishment sunscreens is highlighted, and in winter, the focus are and the brands. the body and lip moisturizers.
Another highlighted area, extremely disputed at the sales point, are the checkouts (exit space, that The sales promotion and is, where the cashiers are arranged with shelves containing goods), where impulse buying usually merchandising team gains traction. These are products that, in most cases, are part of the consumer's shopping basket, however, adds value in ways that they may go unnoticed in the face of so much other consumers don't notice, but information. they certainly appreciate it, But the work is not limited to that. The pharmacy clerk works as an agent in several industry actions and, for as well as the establishment this, needs to be trained, and this training is also one of the activities of this field team. and the brands.
| 39 DIAGNOSTIC MEDICINE
LABORATORIES THAT INVEST IN PATIENT EXPERIENCE ARE AMONG THE FASTEST GROWING, STUDY POINTS OUT
According to "Benchmark "Organizations that are using digital resources, from the first moment of contact with the patient, before Shift 2021: Diagnostic the examination and also at the time of face-to- Medicine Radar", half of the face care, automating processes without losing the humanization, which is a strong characteristic of laboratories surveyed have the health sector, are able to not only serve faster, mobile applications and 42% but also to retain patients. The same goes for when the patient goes home to wait for the results, the of respondents intend to act in reports. The fact that all internal processes are more automated and based on innovations not some way to further improve only promotes greater interaction between patient care in 2021 and laboratory, but also helps to increase quality”, emphasizes Marcelo Lorencin, CEO of Shift.
Although the movement for the search for The diagnostic medicine sector has been quality in the diagnostic medicine sector has undergoing profound transformations, driven by been consolidated in recent years, the digital new technologies and tools that make it possible to transformation is, nowadays, the great differential of process exams in a more efficient, safer and larger laboratories. The correlation between investments scale. Also according to the “Benchmark Shift 2021: in technologies that help improve the patient Diagnostic Medicine Radar”, 49% of laboratories experience and laboratory success is evident in the already provide a mobile service platform for study “Benchmark Shift 2021: Diagnostic Medicine patients and 37% intend to implement the digital Radar” which heard from a group of laboratories that strategy for relationship with their customers. are part of Shift's client base, a company specialized And the trend is for this to continue, as 42% of in Information Technology (IT) for diagnostic respondents intend to act in some way to improve medicine, and which, together, carry out more than the patient experience in 2021. 75 million exams per year. There is also a growing number of laboratories Laboratories with higher billing apparently have more using automated verification solutions that allow agile service processes, recording an average reception you to release exams in a more agile and secure time of 9 minutes. In addition, those who have apps way, with the support of logical scripts that assess for their patients have shown to have a 50% more the biological variation index, comparison of exams efficient service time than those who do not. to check compatibility, among other possibilities.
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Forty-three percent is the average percentage of the volume of exams released automatically through Shift LIS, Shift's module that has this functionality. More than half of laboratories release over 50% of exams through automated verification, and the highest rates have settled above 80%.
In addition, technology and equipment are among the areas identified as the most mature within the organizations of the diagnostic medicine sector, and the vast majority of respondents, over 90%, have already carried out or have projects of this nature planned to be implemented in 2021; and more than 40% plan to open or modernize units this year.
“If we look at the technological side, with the exponential acceleration of digital technologies, artificial intelligence, analytics and data science and many others, there has never been, in the history of medicine, such rapid advances in such a short period of time. On the other hand, there was also a change in the profile and concepts, the behavior of patients and physicians, the expansion of the patient journey, the breaking of borders, and healthcare. The truth is that every day we are surprised by innovations that change the way we see medicine, and the diagnostic medicine sector has to be increasingly prepared for this digital transformation. Those who are not betting on new technologies have to stop and think about it”, concludes Lorencin.
It is worth noting that the sample that participated in the research represents about 20% of the tests carried out by medium-sized laboratories in the country, reflecting the reality of the diagnostic medicine sector, which is not only made up of large networks. Currently, of the 916 million exams performed by private health, about 516 million are Technology and equipment processed by the largest laboratories, according to are among the areas identified the Brazilian Association of Diagnostic Medicine (Abramed). as the most mature within the organizations of the diagnostic medicine sector, and the vast majority of respondents have already carried out or have projects of this nature planned to be implemented in 2021.
| 41 HEALTH AND BUSINESS
HEALTH IN BRAZIL IN 2021: PANDEMIC, MERGERS AND ACQUISITIONS, AND TECHNOLOGY INVESTMENTS
While the new coronavirus pandemic still dominates The great example of this is telemedicine. According the news, keeping the health sector in the spotlight, to the Observatory of the National Association of behind the scenes the sector is undergoing major Private Hospitals (Anahp), 75% of these institutions transformations, with the arrival of new players and in the country already make use of such services and the continuity of mergers and acquisitions (M&A) 58.3% offer their own distance care. movements. But, when talking about technology, we are not This process began in 2015, when Brazilian legislation restricted to remote service. There are different (Law 13.097/2015) allowed foreign investments activities that need to be well integrated so that in the sector, which allowed the injection of more daily processes in hospitals can happen effectively capital into national companies – often based on – and, eventually, a network can operate in sync. An family businesses. example is the electronic medical record, as each one has a different technology and is operated by In this scenario, investors saw the opportunity to numerous teams. create value through consolidation, using some levers. But, after all, what drives this movement? This diversity of systems explains why, after a The answer lies in expanding the customer base, merger or acquisition, IT management becomes in cost synergies, in entering new markets, among even more complex, with the main challenge being other factors. However, this type of process, despite the standardization of technologies. It is necessary allowing rapid growth even in times of crisis, needs a to integrate the technical support service and the lot of planning, focus and attention on the integration databases – unifying the legacy units – to guarantee a of operations to avoid delays and failures. more secure and stable structure. All of this reflects, a lot, on the efficiency of patient care, and, therefore, on It is interesting to note that, although the technology access to medical records, more agile service points, and solutions area is critical for helping to detect as well as access to the Wi-Fi network for those who synergies – reducing the duplication of services, are in institutions or to websites and apps for remote reducing costs and improving team management service and scheduling. In addition, management – as well as for promoting automation and clinical needs to analyze key performance indicators (KPIs) integration, it is often called late to participate in so that metrics are comparable to avoid making M&A processes. decisions based on non-standardized data.
This happens because, within the health sector, due For this year, in addition to the acceleration of M&As, to cultural characteristics, Information Technology (IT) the healthcare market can expect new solutions in is not yet (or was not) at the top of the list of priorities. telemedicine – with the use of wearables, sensors With the arrival of the pandemic, however, the for consultations and innovative technologies for segment ended up being compelled to adopt different diagnostics –, in addition to operational improvements technologies to speed up processes, innovate or – greater processing capacity, speed of response allow some practices to be carried out at a distance. in hospital internal processes, always aiming at
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efficiency gains. Of course, all of this is in balance with the response to the pandemic, which, today, is the priority on the sector's agenda and also demands innovations and investments to be overcome.
It is interesting to note that, although the technology and solutions area is critical for helping to detect synergies – reducing the duplication of services, reducing costs and improving team management – as well as for promoting automation MARCELLO ALBUQUERQUE and clinical integration, it is often called Consulting Director at late to participate in M&A processes. Logicalis.
| 43 44 | LEGAL VISION VISÃO HOSPITALAR MAGAZINE
THE ENTRY INTO FORCE OF GDPR SANCTIONS
The fact is that the vast majority of entities representing the business sector, including small and medium-sized hospitals, clinics and laboratories, are not fully prepared to undergo any inspection action by the National Data Protection Authority (NDPA).
Law No. 13.709, of August 14, 2018 (General Data Protection Regulation - In Portuguese, Lei Geral de Proteção de Dados - LGPD), provides that the provisions on sanctions come into force on August 1, 2021. Considering that the GDPR itself came into force in the second half of September 2020, it is correct to say that individuals or legal entities that process personal data have had a little less than a year to adapt to the new legal obligations.
Although it is possible to argue that the GDPR was approved in the year 2018, and therefore its provisions are generally known since then, the fact is that the vast majority of entities representing the business sector, including small and medium hospitals, clinics and laboratories, is not fully prepared to undergo any inspection action by the National Data Protection Authority - NDPA (In Portuguese, Autoridade Nacional de Proteção de Dados - ANPD), especially because of the Covid-19 pandemic that continues to pressure the Health Sector. LIDIA HATSUMI YOSHIKAWA The submission of the proposed Inspection Lawyer of FBH. Assistant General Secretary of Resolution to public consultation by NDPA, the Institutional and Governmental Relations published on May 25, 2020, which aims to regulate Commission and member of the Administrative Law Commission of the OAB – Federal District the procedure to be adopted for inspection and the Section. Member of the Business Front in Defense application of sanctions, should be commemorated. of the GDPR and Legal Security. Its content demonstrates that NDPA is in line with the best practices of responsive action. | 45 LEGAL VISION
Some initial points dealt with in the proposal certification bodies or other responsible entities. The deserve to be highlighted: the special attention administrators or their representative associations given to monitoring, guidance and preventive action may suggest the adoption of these guidance procedures, which precede the beginning of the measures, under the NDPA’s assessment. Thus, it is repressive process by NDPA; and the fact that the recommended that entities develop codes of conduct monitoring procedure will involve the gathering of and good practices. information necessary for NDPA to be made aware of the regulated environment and the demands of data Finally, we highlight the so-called Compliance Plan subjects, processing agents and those interested in as a preventive measure that can be adopted. This the protection of personal data. instrument must contain, at a minimum, the object, the deadlines, the actions planned for the reversal of It is also worth emphasizing the guiding assumptions the identified situation, the monitoring criteria and provided for NDPA’s supervisory action, such as the trajectory for achieving the expected results. In responsive action, with the adoption of measures addition to this instrument, the proposal provides proportional to the identified risk and the attitude for the Term of Adjustment of Conduct as one of of those under management, encouraging the the possible conducts after the opening of the promotion of a culture of personal data protection sanctioning process. and providing for mechanisms of transparency, feedback and self-regulation. By the way, it is here The GDPR establishes the sanctions and legal limits to ratify the importance of self-regulation for the to be observed in the regulation of the sanctioning Health Sector as a measure of self-protection and administrative procedure and imposes that the legal security. penalties be applied gradually, proportionally and according to the degree of damage, the economic The proposed Audit Resolution in public consultation condition and good faith of the offender, among also indicates guidance measures, among which other parameters. is that of recommending the observance of codes of conduct and good practices established by With regard to sanctions, the GDPR determines that the NDPA must publish the methodologies that will guide the calculation of the base value of the fine. In addition, it imposes that the regulation of sanctions and methodologies must establish the circumstances and conditions for the adoption of a simple or daily fine.
In these terms, as we understand it, NDPA did well in terms of regulating the sanctioning procedure, but remained silent on the necessary treatment of sanctions and mandatory elements that should be included in the notice of infraction, – such as the penalty to be imposed – without which the infringing entities will not be able to exercise their right of defence.
In view of these considerations, it is clear that health entities, regardless of size, have much to contribute to NDPA so that the entry into force of GDPR sanctions is accompanied by a responsive action that guarantees the legal certainty necessary for the consolidation of the regime applicable to the protection of personal data in the country.
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SUPPLEMENTARY HEALTH GAINED 1 MILLION NEW BENEFICIARIES DURING THE PANDEMIC
According to data from FenaSaúde and ABRH-RJ, the number of users in the private network reached 48 million, the highest level since September 2016. But there is still room to grow, as half of the workers with a formal contract do not have health insurance
Health plans are the second main item of desire of Brazilians, after home ownership, and with the pandemic, it has become even more relevant, especially for company employees. Between March 2020 and March 2021, the Supplementary Health system gained the adhesion of 1 million new users and reached 48 million beneficiaries, the highest level since September 2016. The increase was greater in corporate collective plans, which grew 2.48% (collective membership + 1.37%) and currently represent 80% of beneficiaries.
Although it has led the way, the collective plans still have a lot of room to grow. Data from the General Register of Employed and Unemployed (Caged) show that half of people with a formal contract do not have health insurance. This is the assessment by the executive director of the National Federation of Supplementary Health (FenaSaúde), Vera Valente,
| 47 HEALTH INSURANCE
who participated in the Virtual Forum on Health TELEHEALTH and Welfare of the Brazilian Association of Human Resources of Rio de Janeiro (ABRH-RJ) in the Telehealth was another service much sought after by "Solutions in times of pandemic" panel. beneficiaries since the beginning of the pandemic and helped to protect employees from the risks of At the meeting, the executive highlighted the Covid-19. Between February 2020 and January this role of the Supplementary Health sector, which year, 2.6 million remote services were provided in currently has 700 healthcare providers in Brazil. the country, according to a survey by FenaSaúde. In "Our 48 million beneficiaries correspond to a the period analyzed, 60% of the total visits were population equal to that of a country like Spain. for emergencies and 40% for elective cases. In One in four Brazilians is assisted by a private addition, more than 80% of patients had their needs health care plan," she said. met remotely. Also according to the survey, customer satisfaction was between 75% and 94%, depending According to the Occupational Doctor and on the operator. responsible for Corporate Health and Life Quality at Light, the pandemic has caused employees to "Telehealth has become a solution even for serious take more care of their health and, therefore, they cases. This resource has helped us organize access are using even more the services of the plans in to medical and hospital services at this time search of well-being and quality of life. "We noticed of pandemic", stated Vera Valente. "The long- that many employees are looking to nutritionists distance service was also important for the medical to have a healthier diet, and others are looking for profession, which managed to assist their patients by specialists in physical activity," she said. performing remote consultations, thus maintaining their income", added the FenaSaúde executive.
LESSONS FROM THE PANDEMIC
The new coronavirus pandemic has led society as a whole to reflect on the functioning, needs and weaknesses of health in Brazil and in the world. The director of FenaSaúde defends that the country builds a regulation that allows to bring more beneficiaries to the Supplementary Health, and, thus, manages to relieve the public system.
“One of the possible paths is the expansion of individual and business plans. And a company, by giving this benefit, contributes to the employee and the country, leaving the SUS [Unified Health System] to those who need and depend on the public system", she said. "The need for the public and private sectors to work together and in a coordinated manner has never been more evident. Health needs complementarity between public and private", she emphasized.
"Our 48 million beneficiaries correspond to a population equal to that of a country like Spain. One in four Brazilians is assisted by a private health care plan." – Vera Valente, executive director of FenaSaúde. 48 | INNOVATION AND HEALTH VISÃO HOSPITALAR MAGAZINE
SHO: INNOVATION AND MANAGEMENT EFFICIENCY
Over two decades ago, an innovative administrative model for the management of public facilities was created in Brazil. These are non-profit private entities, called social organizations, which manage public services in various sectors, such as health, culture, education, environmental protection, technological development and scientific research.
In the health area, the concept of social health organizations - SHO (In Portuguese, Organizações Sociais de Saúde - OSS) is innovative and allows the State to offer integral care through the Unified Health System (SUS), through private management tools that are often more agile and efficient compared to government public sector norms.
Municipalities and state governments sign management contracts with previously qualified organized civil society entities for the management of public hospitals and equipment such as medical clinics, health posts, emergency care services and diagnostic imaging laboratories, among other services.
Through these instruments, institutions have quantitative and qualitative goals to meet and work in accordance with the guidelines established by public managers in view of local and regional health needs. The State is responsible for transferring the necessary resources for the management of the unit and for controlling and supervising the performance of social organizations in relation to the goals, production and quality of the services provided.
| 49 INNOVATION AND HEALTH
During this period, the SHO significantly expanded With the support of philanthropic institutions with the population's access to public health, taking care expertise in health, since March 2020, it has been to regions far from large urban centers, representing possible to provide a quick, efficient and quality a great advance for Brazilian public health. Currently, response to the demands of Covid-19, both in terms the model is present in more than 200 Brazilian of infrastructure, hiring staff and purchasing of municipalities, 23 states and the Federal District. medicines and supplies.
The implementation of the model, in 1998, Through the SHO, more than 6.500 beds were allowed public hospitals more agility in private activated in Brazil, 3.200 of them in the Intensive management mechanisms, with autonomy for the Care Unit (ICU), according to a survey among the human resources area and for managing stocks of SHO associated with the Brazilian Institute of Social medicines and hospital supplies, which ensured Health Organizations (Ibross). greater productivity. That is, the government guarantees greater health care for the population. Created in 2015, Ibross is the first entity to represent SHO in Brazil. The institute works with Comparative works demonstrate that the the objective of contributing to the qualification management model improves the quality of public and sustainability of the SUS. There are currently spending and increases management productivity. 19 member institutions operating in eight Brazilian A recent study by the São Paulo State Department states and the Federal District. of Health, where the model emerged, pointed out that hospitals managed by SHO stood out in terms The responsible use of innovative and creative of efficiency and cost-effectiveness in serving the management models, such as those of social population using SUS. organizations, can be a fundamental action to provide solutions to increase the production of The numbers corroborate this statement. For a health equipment with quality and efficiency, SHO, in 2016, the cost per admission was 25.9% enabling the strengthening of the SUS and excellent lower than in hospitals under direct administration. results for society. The average length of stay of patients in hospitals managed by social organizations was 5.64 days, 20.1% less than in those of direct administration The responsible use of innovative and – indicating greater effectiveness of treatments applied in services administered by SHO. creative management models, such as those of social organizations, can be a The study also found that, in units managed by social fundamental action to provide solutions organizations, the total number of hospital surgeries per room was 49.8% higher than in hospitals under to increase the production of health direct administration. Cesarean rates were also equipment with quality and efficiency, 18.5% lower in SHO. enabling the strengthening of the SUS and In addition, the Covid-19 pandemic has excellent results for society. demonstrated the importance of the SUS, as four out of five Brazilians depend exclusively on the system in their service bases. FLÁVIO CLEMENTE DEULEFEU SHOs are at the forefront in fighting this pandemic President of the Brazilian Institute of Social Health and have been standing out in providing quality Organizations (Ibross) and the Institute of Health medical care in health services. and Hospital Management (ISGH).
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A YEAR OF TELEMEDICINE IN BRAZIL: HEALTH PLANS RECORDED MORE THAN 2.5 MILLION CALLS
By Felipe Nabuco [email protected]
About a year ago, the National Congress approved, provisionally and on an emergency basis, Law No. 13.989/2020, which instituted the use of telemedicine in Brazil. The measure was conceived as a prompt response by the Brazilian health system to the sanitary crisis scenario, configured by crowded emergencies and professionals exposed to the risks of contamination.
After 12 months, in case there is still any doubt as to whether the practice is here to stay in Brazil, the numbers of this first year of regulation speak for themselves. According to surveys by the main entities representing the sector, such as the Brazilian Association of Health Plan (Abramge) and the Brazilian Federation of Supplementary Health (Fenasaúde), between April 2020 and March this year, private health recorded more than 2.5 million teleconsultations. In addition to helping to relieve hospitals, taking in a large number Surveys show that, of this total, about 60% of of patients who would certainly the visits were urgent, while the remaining 40% increase the burden of care even more, referred to elective cases. Efficacy and safety were telemedicine also helped to protect also evaluated. According to Abramge, among the health professionals, preventing their teleconsultations registered, around 90% of cases were resolved remotely. In other words, for every exposure to contamination.
| 51 TELEMEDICINE
ten patients seen, nine did not need to go to the authored by federal deputy and president of the hospital, avoiding exposure to the coronavirus. Mixed Parliamentary Telehealth Front, Adriana Ventura, authorizes the use of telemedicine on an BENEFITS emergency basis, only during the coronavirus crisis. Therefore, an amendment with an extension of Experts are unanimous in ratifying the gains the term or the creation of a new law will still be provided by the regulation of telemedicine for the necessary so that the practice can continue. entire country. In addition to helping to relieve hospitals, taking in a large number of patients Abramge understands that the final approval of who would certainly increase the burden of care the law will facilitate the coordination of care even more, telemedicine also helped to protect with primary care, access to doctors, in addition health professionals, preventing their exposure to to reducing the high demand for screening and contamination. emergency care. “The exponential growth of telemedicine is also a reflection of the satisfaction “The Covid-19 pandemic has been a major of beneficiaries of health plans. Regulation is a catalyst for a series of changes that hospitals fundamental advance for medicine. We are in have been experiencing in recent months. Digital constant contact with the responsible authorities technologies have been of paramount importance to present data and information that corroborate for the improvement of services provided in health the decision made”, evaluates Renato Casarotti, facilities, and telemedicine has shown that its president of Abramge. results are essential for the sustainability of the Brazilian health system" evaluates the president of According to Régis Corrêa, Health Director at Hygia, the Brazilian Hospital Federation (FBH), Adelvânio a Brazilian startup that operates as fintech and Francisco Morato. healthtech, one of the main aspects of the law that were observed by health service providers was to According to him, the benefits are numerous and ensure the security of patient information within go far beyond shortening distances between doctor the standards provided for by the General Data and patient. “It [telemedicine] has enabled medical Protection Regulation (In Portuguese, Lei Geral de care in places where there are no professionals. Proteção de Dados - LGPD), Law No. 113.709/2018), This means that the population's access to care is which came into force in August 2020, preventing being expanded. It has also helped to relieve the data leakage and considering sanctions ranging from emergency, preventing the patient from going to warnings to fines. the health center, and, therefore, helping to restrict the movement of people at this time of pandemic. Corrêa also points out that there is already a It is necessary to emphasize that, in this crisis, consensus within the Federal Council of Medicine telemedicine was of paramount importance for (FCM) and entities that control medical regulation monitoring patients with diseases that cannot have for the maintenance of remote health care. “This is their treatment interrupted, in addition to offering one of the pillars of telemedicine, giving legitimacy mental health consultations with psychiatrists and to the medical act. So much so that, at the time it psychologists”, adds Morato. was sanctioned, the use of digital certification in the ICP-Brasil standard was recommended, which REGULATION is a standard of cryptographic keys regulated by the Information Technology Institute (ITI), linked to Even in the face of so many benefits to the Brazilian the Ministry of Planning, in which it is possible to health system, the practice of telemedicine is still determine that a qualified doctor performed the not definitively regulated in Brazil. Law No. 13.989, service”, details the Health director.
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| 53 DIGITAL HEALTH
COMPANIES CREATE ASSOCIATION TO SUPPORT THE SUSTAINABLE DEVELOPMENT OF THE SECTOR
Aiming to ensure that technology fulfills its role of “We believe in full telemedicine and in its vital role expanding access to healthcare and increasingly in achieving our goals and guaranteeing a dignified, placing the patient at the center of care, entities that quality, but also agile, efficient and rational service. operate in the telemedicine service supply chain and The use of electronic resources can increase patient that develop activities related to digital health united engagement, making you the greatest partner in your around this common cause and founded the Brazilian own healthcare. It is this autonomy of choice that Association of Telemedicine and Digital Health should guide the act of caring for people, regardless Companies, known as Saúde Digital Brasil (SDB). of the health professional. Especially in the case of doctors, they have the conditions to choose whether The SDB is a non-profit organization that emerges or not to use teleconsultation or teleorientation”, with the main objective of ensuring the continuity, explains Eduardo Cordioli, president of the SDB. even after the pandemic, of health care through telemedicine and telehealth, throughout the national As a non-profit association, the SDB also aims to territory, in addition to enabling universal access, contribute to the improvement of the care model, increasing development scientific-technological the creation of a regulatory framework and the and innovation in health. qualified and sustainable development of the health sector. At the head of the organization are Eduardo Cordioli (president and representative of the Albert Einstein Hospital) and Caio Soares (vice-president and THE ROLE OF TELEMEDICINE AND representative of Teladoc), supported by Fábio Luís DIGITAL HEALTH Pinto Tiepolo (Docway member), Guilherme de Souza Telehealth and telemedicine, which, during the Weigert (Conexa member), Fábio Cunha (Dasa member) pandemic, gained the spotlight and saved many and Wilson Shcolnik (Santecorp/Fleury member). lives, are undoubtedly tools that increase access to healthcare and reduce costs. A large portion of the Working groups were organized to encourage population was safely assisted and companies took discussion of specific topics, such as information proper care of their employees using technology. and systems security, including electronic medical Through them, it is possible to improve the patient records; prescription and dispensing of medications; experience, reduce waste, avoid delays in diagnosis interoperability between the Unified Health and conduct, and, therefore, bring more quality to the System (SUS) and Supplementary Health systems; population's health. clinical protocols and best care practices related to telemedicine, such as informed consent, distance “If they were so relevant this past year, precisely action limits, among others; and relationship with because they expanded access and directed the Medical Specialty Societies. patient to the most appropriate place for their
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care journey, why could they not be used after this SDB is a non-profit entity whose goal is period? Which country in the world constitutes an army only in wartime? Could it be that this is to expand patient access to physicians not the tool to really exponentialize the access through the use of technology, of the Brazilian population to health? For a more humanized care, for a population already sacrificed? enabling not only universal access, The way out for an important reduction in pressure but also the increase in scientific- for service in the public system? Learning doesn't stop. You must always be alert, training and technological development and improving the use of technology, even in times of innovation in health, even in the post- normality”, provokes Cordioli. pandemic world.
| 55 MANAGER SPEECH
MAURÍCIO ESSVEIN FOGAÇA, EXECUTIVE DIRECTOR OF THE NOSSA SENHORA DE FÁTIMA WOMEN'S HOSPITAL AND MATERNITY HOSPITAL, IN CURITIBA-PR
By Amanda Vasconcelos [email protected]
“Nobody is born ready. job with excellence. Nobody is born ready. People are getting ready to fill management positions. People are getting ready to fill And today, thanks to God, to my studies and my management positions” career, I feel prepared to be where I am.”
Maurício Essvein Fogaça is the executive director As a manager does not live only in theory, it is of the Nossa Senhora de Fátima Women's Hospital necessary to balance it with practice, the director and Maternity Hospital, located in Curitiba-PR of the Nossa Senhora de Fátima Women's Hospital and focused on women's health in all stages of and Maternity Hospital recalls a little of the life. His trajectory in the hospital area began in experiences he has had over his 28-year career. 1993, when he enrolled in a degree in Hospital Administration. Since then, many other titles “In 1993, I joined the Faculty of Hospital have been acquired (post-graduate in Financial Administration at Unisinos and did an internship Administration, post-graduate in Strategic at the South Hospital Management at São Camilo, Administration and Master in Administration and in São Paulo, where I had my first professional Business). A qualified manager cannot remain experience and which lasted for seven years. stuck in time. In the digital age we are living in, Afterwards, I received several promotions until you must always stay up to date. Innovations arise I left as deputy director of a hospital. From São all the time. And that is why Fogaça is currently Camilo, I moved to a congregation of sisters in being selected for admission to the doctorate in Rio Grande do Sul which, at that time, had 11 Administration. hospitals.
“One of the functions of those who assume a Between 2001 and 2002, I started teaching. In the leadership position is precisely to train successors. same period, I was starting work in the state of What does a person need to be at the head of a Mato Grosso, in Rondonópolis, and I was selected hospital, in a management area? He/she must have as the director of a public hospital that I was an academic background, practical knowledge of helping to implement. It was my first experience the segment and the desire to really perform the as a hospital director.
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moment of great learning in the reformulation of the plan, when we developed a partnership with the National Supplementary Health Agency (ANS), the Pan American Health Organization (Opas) and the Brazilian Association for Quality of Life (ABQV).
From there I went to Florianópolis as general director of the Hospital de Caridade, a large establishment in the state of Santa Catarina. Then I left the Santa Casa in Florianópolis and went to the Santa Casa in Porto Alegre, where I implemented a new hospital, with about 100 beds, in a town called Santo Antônio da Patrulha. I also worked in São Miguel do Iguaçu, in the interior of Paraná, implementing another 300- bed hospital. Later, I was transferred to Santa Casa de Curitiba.
Finally, I was looking for a place to stay for the next 25 years until I retired. I have been looking for this for some time and I had the opportunity to be introduced to the Sisters Congregation of St. Joseph of Chambéry, who are the maintainers of the hospital I am in today, an institution that has principles, strength and growth opportunities in a market that is totally under reorganization here in Curitiba.”
In 2002, I was selected by Cassi to be the regional During all these years in the health market, market relationship manager in Rio Grande do Sul. Fogaça took an important lesson. “The patient After completing my master's degree, I was transferred must always come first. This quote I took from from Cassi in Porto Alegre to Cassi in Curitiba. I the Canadian QMentum accreditation program, exercised the role of director of the Associative Entity which I participated in between 2008 and 2009, of Self-Management Health Plans, which is called and it really makes perfect sense, as care comes Unidas. Unidas has its state superintendencies, and first, closer to the patient. So, my role, as a here, in Paraná, I was the superintendent director, director, is to provide support so that each person responsible for the relationship with the hospitals. in this group, from assistance to administrative From Cassi I went to Capesesp, in Rio de Janeiro, as demands, can, at the time of the patient's need, the Health Plan director. have the capacity to deliver a good service. We need to empower the team and, of course, Afterwards, I received an invitation to return to work with real-time goals and indicators in the Curitiba as superintendent director of Hospital Vita hospital. I know exactly the number of births, Batel, an establishment still in its early stages. We the number of surgeries, everything that is developed an ONA national accreditation project happening here, practically in real time, with a at levels 2 and 3, and subsequently achieved a 5 minutes delay ”. Canadian international accreditation, QMentum methodology. So, the golden tip is: try to plan all other hospital resources based on the patient's needs. This makes I was also invited to be superintendent of the one have greater assertiveness, because without Health Plan of Companhia de Energia Elétrica do the patient, everything else would not exist. Paraná (Copel), with 42 thousand lives. It was a
| 57 ELECTRICITY
LEARN HOW TO REDUCE YOUR COMPANY'S ELECTRICITY BILL BY UP TO 30%
Do you know what the free energy market is and how HOW DOES THE FREE ENERGY it works in Brazil? Today, more than 7,000 companies MARKET WORK? already enjoy the freedom of negotiation and the economy that the Free Energy Market provides. As the name implies, companies that join this market These customers are the largest energy consumers are free to buy energy from the supplier they deem in Brazil, representing 30% of the entire load in the most interesting, taking into account issues such as electricity sector, according to an exclusive survey the price charged, security of supply and the type by the Electric Energy Commercialization Chamber of generating source. This purchase can be made (CCEE). directly from the generating companies (the plants) or from the trading companies, through a contract Want to know the benefits and prerequisites negotiated between the parties. for migrating? CPFL Soluções has been helping companies throughout Brazil to improve energy Similar to the telephone sector, the Free Energy efficiency and, as a result, save resources to invest Market allows consumers to exercise their portability in their businesses. right also in the electricity sector. For your company
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In addition to the savings at the time of contracting, the Free Energy Market offers companies other advantages:
Discount on TUSD and TUST – To promote the expansion of the use of alternative energy generation sources, legal incentives were created for both suppliers and consumers. Thus, enterprises that invest in the purchase of energy from renewable sources can benefit from a reduction in Transmission Systems Usage Tariffs (In Portuguese, Tarifas de Uso dos Sistemas de Transmissão - TUST) and Distribution Systems Usage Tariffs (In Portuguese, Tarifas de Uso dos Sistemas de Distribuição - TUSD), which can range from 50 to 100%.
Budget planning – Predictability is essential for companies' financial planning. When negotiating directly with the supplier, prices are defined for the duration of the contract, allowing customers to know how much they will pay.
Absence of Tariff Flags – In the captive market, the consumer is subject to the Tariff Flags every month, a system through which ANEEL defines, month by month, whether the electricity bill will be more or less expensive, according to the conditions of electricity production that moment. In practice, this is what makes the residential electricity bill, for example, more expensive in months without rain, when the country's energy generation capacity is lower. As the contracts are negotiated directly with the generators, the Tariff Flags do not apply to the Free Energy Market, which allows for more predictability and less variation in the company's costs.
Sale of surplus energy – If companies that joined the Free Energy Market do not consume all the to join, it is enough to have a total contracted energy contracted, they can request authorization demand from 500 kW, which means a monthly bill from ANEEL to trade the surplus with other market between R$ 60.000 and R$ 80.000, approximately. agents, thus optimizing resources. Even better: this wage can be reached with the sum of different units. The Free Energy Market is a safe and advantageous option that offers companies the freedom to HOW CAN THE FREE ENERGY choose the best supplier, based on criteria that are MARKET BE GOOD FOR interesting to their business, promoting efficiency COMPANIES? and economy. Within this context, CPFL Soluções is able to offer the Free Energy Market and all its When buying energy directly from generators or benefits. Through solutions designed and executed traders, you have greater bargaining power and, with excellence, in addition to a qualified team consequently, a reduction in the cost of contracted of specialists, the company always seeks to energy. In a conservative estimate, the Free Energy make its customers' business more competitive Market can provide savings of up to 30% compared and sustainable. Count on CPFL Soluções: www. to the Regulated Market. cpflsolucoes.com.br
| 59 FBH AT THE CONGRESS
Dulci Tiné Parliamentary advisor to the Brazilian Hospital Federation (FBH). PROVISIONAL MEASURES REEDIT TAX REFORM LABOR MEASURES DURING THE The president of the Federal Senate, the president of the Chamber of Deputies and the minister of FIGHT AGAINST THE PANDEMIC Economy met to discuss the tax reform slicing, at the request of minister Paulo Guedes and deputy Arthur Lira. An agreement was signed, in which Provisional Measure nº 1.046/2021, published by the Senate will be responsible for analyzing the the federal government in April, is intended to be a constitutional reform in tax matters and the new re-edition (former Provisional Measure nº 297/2020) Refis, while the Chamber will be in charge of the that deals with labor measures to be adopted by Executive initiative projects sent to the Legislative, employers to fight the Covid-19 pandemic. Among the such as the discussion of the Income Tax (IR), the measures foreseen are the anticipation of individual Tax on Industrialized Products (IPI), the Social vacations, the granting of collective vacations, the Integration Program (PIS) and the Contribution for use and anticipation of holidays, the bank of hours Social Security Financing (Cofins). and the suspension of administrative requirements in Occupational Health and Safety. It also contains Texts from some infra-constitutional Bills (In rules to encourage adherence to telework. Portuguese, Projetos de Lei - PLs) that are already being processed should be used, such as PL No. During the 120 days, companies will be able to 3.887/2020, authored by the government and change the face-to-face work regime to telework, which aims to establish the Contribution on Goods to remote work or to another type of distance work. and Services (CBS) and PL nº 4.728/2020, authored Regarding vacations, the proposal authorizes the by senator Rodrigo Pacheco (DEM/MG), which deals concession even if the vesting period has not elapsed. with the new Refis to remodel the income tax (both The employer may choose to pay the additional one- for legal entities and individuals) and its main idea third of the vacation after it is granted, up to the date is to reduce the income tax of the person legal that is due to the 13th salary. entity, but taxing the distribution of profit, and on Prior communication to the local agency of the the individual's side. The intention is to increase Ministry of Economy and communication to trade the income tax exemption range, but eliminate unions representing the professional category are the exemptions for investments that promote waived. The only requirement is prior notice to the the economy, such as Certificates of Real Estate workers (48 hours before the decision). Receivables (CRI) and Agribusiness (CRA). Probably, the first project to be analyzed will be the creation of CBS at a 12% rate, in place of PIS and Cofins.
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NEW PROJECT EXTENDS TARGET SUSPENSION TO SUS SERVICE PROVIDER
Bill No. 4.384/2020, which suspends, until the end of quantitative and qualitative goals established in this year, the obligation to meet targets for entities that contract within the SUS. This will allow the receipt provide health services for the Unified Health System of transfers of the financial amounts provided for (SUS) is on the Social Security and Family Committee of in the contract, even if the targets for this year are the Chamber of Deputies, reporting by Deputy Pedro not met, due to the pandemic. The proposal also Westphalen (PP/RS), after approval in the Senate. includes social health organizations (In Portuguese, organizações sociais de saúde - OSS) among the The text will allow health service providers to be entities benefiting from this measure. released, until the end of the year, to meet the
PROJECT ON THE WAGE FLOOR AND 30 HOUR DAY OF NURSING
Bill No. 2.564/2020, which deals with the floor and to expose the president of the Senate, party leaders working hours of Nursing, provides for a minimum and other senators the financial impact brought by the salary for nurses of R$ 7.315,00 per month; for Nursing project, if approved, and requesting the expansion of technicians R$ 5.120,50; and for Nursing assistants, the debate, including involving the Senate Committees R$3.657,50 per month, based on a 30-hour working day. on Merits, such as the Committee on Economic Affairs (CAE), the Committee on Social Affairs (CAS) and the The Brazilian Hospital Federation (FBH) has worked Committee on Constitution and Justice (CCJ). strongly, together with other entities in the Health Sector,
BILL PROPOSES TO RESUME THE RULES FOR EMERGENCY SITUATION DURING THE PANDEMIC
Bill No. 1.315/2021, authored by senator Rodrigo Chamber of Deputies, with the report of the deputy Dr. Pacheco (DEM/MG), proposes to reestablish the Luiz Antônio Teixeira Jr. (PP/RJ). measures to deal with the emergency in public health due to the Covid-19 pandemic, re-editing those whose The project has some differences from last year, such as effects ceased in 2020. Now, the proposal is in the the expansion of priorities for vaccination and care in Social Security and Family Commission (CSSF) of the hospitals, and also provides that the measures will be valid until the official recognition of the end of the pandemic.
ADMINISTRATIVE REFORM (PEC NO. 32/2020) The Constitution and Justice Commission (CCJ) of the President of the Republic to extinguish entities of the Chamber approved the admissibility of the Constitutional autarchic and foundational public administration. Amendment Proposal (PEC) nº 32/2020, which proposes a reform in the public administration. The rapporteur, The Special Committee will discuss the merits of the Deputy Darci de Matos (PSD/SC), presented his opinion matter. The appointed rapporteur, Deputy Arthur Maia with three deletions to the text: 1) new principles (DEM/BA), informed that he intends to include in the of public administration: impartiality, transparency, proposal the employees of the Judiciary, Legislative and innovation, responsibility, unity, coordination, good Public Ministry, in addition to the military. public governance and subsidiarity; 2) prohibition for After analysis by this Special Committee, the PEC must civil servants occupying typical positions in the State to be approved in two rounds in the Plenary of the Chamber exercise any other paid activity; and 3) the right of the before moving on to the Federal Senate.
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| 63 EVENTS CALENDAR
HEALTH SECTOR EVENTS 2021 CALENDAR
AUGUST AUGUST
HOSPITALAR – DIGITAL JOURNEY 72ND CBEN - BRAZILIAN CONGRESS OF NURSING Date: August 16 to 26 Date: August 25 to 28 Site: www.hospitalar.com/pt/home.html Location: Florianópolis-SC Performed by: Brazilian Association of Nursing (ABEn) – Santa Catarina Site: http://www.abeneventos.com.br/72cben/index.html
SEPTEMBER SEPTEMBER
38TH BRAZILIAN CONGRESS ON EXTRACORPOREAL VI COBRAFIN – BRAZILIAN CONGRESS OF NEUROFUNCTIONAL PHYSIOTHERAPY CIRCULATION Date: September 3 to 6 Date: September 3 to 4 Performed by: Brazilian Association of Neurofunctional Location: Pontifical Catholic University of Rio Physiotherapy (Abrafin) Grande do Sul (PUCRS) – Porto Alegre-RS Site: https://www.cobrafin.com.br Performed by: Brazilian Society of Extracorporeal Circulation and Brazilian Society of Cardiovascular Surgery Site: https://sbcec.com.br/br
SEPTEMBER SEPTEMBER
HOSPITALAR XIX BRAZILIAN CONGRESS ON OBESITY AND Location: São Paulo Expo – São Paulo-SP METABOLIC SYNDROME Site: www.hospitalar.com/pt/home.html Date: September 23 to 25 Location: Expogramado – Gramado-RS Performed by: Abeso Site: https://www.abeso2021.com.br
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OCTOBER OCTOBER
XXXVIII CBP | BRAZILIAN PSYCHIATRIC HOSPITALMED ASSOCIATION – ABP Date: October 20 to 22 Date: October 6 to 9 Location: Pernambuco Convention Center – Recife-PE Location: FIERGS Convention Center – Porto Alegre-RS Performed by: ABDEH Performed by: Brazilian Psychiatric Association (ABP) Site: https://hospitalmed.com.br/feira/ Site: http://www.cbpabp.org.br/hotsite/inscricoes
NOVEMBER NOVEMBER
21ST BRAZILIAN CONGRESS OF PEDIATRIC GLOBAL SUMMIT TELEMEDICINE & DIGITAL HEALTH INFECTIOUS DISEASES Date: November 9 to 12 Date: November 4 to 6 Performed by: Transamérica Expo Center Performed by: Brazilian Society of Pediatrics (SBP) Site: http://telemedicinesummit.com.br Site: https://www.sbp.com.br/especiais/congresso-de- infectologia-pediatrica-2021/
NOVEMBER NOVEMBER
11TH BRAZILIAN CONGRESS OF EPIDEMIOLOGY XXII BRAZILIAN CONGRESS OF INFECTOLOGY Date: November 13 to 17 Date: November 23 to 26 Location: Fortaleza-CE Location: Goiânia Convention Center – Goiânia/GO Performed by: Brazilian Association of Public Performed by: Brazilian Society of Infectology (SBI) Health (Abrasco) Site: https://infectologia.org.br/2021/01/12 Site: https://epi.org.br/index.php
NOVEMBER NOVEMBER
VIII BRAZILIAN CONGRESS ON WOUND FCE PHARMA PREVENTION AND TREATMENT Date: November 30 to December 2 Date: November 29 to December 2 Location: São Paulo Expo – São Paulo-SP Location: Frei Caneca Convention Center – Organization and promotion: NürnbergMesse São Paulo-SP Site: https://www.fcepharma.com.br Performed by: Sobenfee Site: https://www.sobenfee.org.br/feridas2021
DECEMBER
41ST BRAZILIAN HAND SURGERY CONGRESS Date: December 9 to 11 Location: Windsor Barra Hotel & Congressos Performed by: Brazilian Society of Hand Surgery (SBCM) Site: https://mao2021.com.br/ | 65 ECONOMIC INDEX
INFLATION INDEX (%) PERIOD MONTHLY 12 MONTHS
IPCA (%) May/2021 0,83 8,06
INPC (%) May/2021 0,96 8,90
IPCA-15 (%) June/2021 0,83 8,13
IPC FIPE (%) May/2021 0,41 8,50
IGP-M (%) May/2021 4,10 37,04
IGP-DI (%) May/2021 3,40 36,53
IGP-10 (%) June/2021 2,32 36,94
Sources: IBGE, Fipe, FGV and Dieese. Elaboration: Valor Data.
APPLICATIONS INDEX IN % Selic over, per year 4,15
CDI over Cetip, per year 4,15
DI Future, per year (October/2021) 4,77
TR (June 25) 0,0000
TBF (June 25) 0,3044
Previous savings (March 18) 0,5000
New savings (March 18) 0,2019
Sources: Banco Central and B3. Elaboration: Valor Data.
FIPE HEALTH MONTH YEAR % April 2021 1,71 May 2021 1,10 June 2021 0,62
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