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VISÃO HOSPITALAR MAGAZINE
A CHALLENGING SCENARIO
In 2020, we had the opportunity to move forward and continue with the most challenging scenario in recent times. With it, we learn to value even more our most precious asset: health.
We started, in 2021, not only a new cycle, in which we renew our strength to overcome all obstacles that have not yet been overcome, but we remain confident and joining efforts with authorities, institutions and all providers and professionals who work in the Hospital Sector to continue this front line focusing on promoting health and well-being.
We learned that unity builds a much greater strength than we could have had in isolation. This connection between Adelvânio Francisco Morato companies, professionals and industries promoted a sum of incredible results in a short period of time. It is impressive President of FBH that, in a year, we have advanced some decades, and our history will be marked not only by the speed in building responses, treatments and solutions, but for professionalism and quality in the provision of hospital services.
On behalf of the Brazilian Hospitals Federation (FBH), I would like to thank you for the achievements and lessons WORD FROM learned and invite each hospital manager to start together a THE PRESIDENT new era of improvements and opportunities. Challenging scenarios always present the best in us!
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
| 3 EXPEDIENT WORD FROM
Chief editor Viviã de Sousa - 12118/DF THE EDITOR [email protected]
Graphic Project With all the difficulties faced by the Health Sector, Viva Comunicação Group vivacomunicacaogroup.com this segment showed its strength and importance throughout the battle against Covid-19. It became Marketing [email protected] much clearer to understand the challenges and reality faced daily by professionals and companies working in Executive production Rosana Oliveira the area. Hospitals and providers in the segment await [email protected] the approval of projects aimed at economic recovery Translation and Proofreading to continue their journey and continue to develop Jaqueline Rodrigues the sector that most employs and pays taxes in the Guilherme Franco Santos country. Content production Felipe Nabuco In the latest editions of Visão Hospitalar Magazine, [email protected] we present scenarios, research and experiences that Print run expanded the reach of their messages to contribute 7 mil exemplares to decisions, choices and reflections by managers and Art and Layout executives who work in the Health sector and follow Viva Comunicação Group vivacomunicacaogroup.com us to discuss information and strategies for decision making. Publication Quarterly In 2021, the mayors chosen by voters start a new journey and appoint new municipal health secretaries, who take on the challenge of facing the second wave of coronavirus and managing the crisis with limited resources.
Keep an eye on the main news and articles that we have prepared specially to start a new year with many possibilities and scenarios. How about we reflect together on the main events in the sector?
Federação Brasileira de Hospitais - FBH HAVE A NICE 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
IHF TASK FORCE 14 DATA PROTECTION 19 HOSPITALAR 2021 21 REFERENCE HOSPITAL 24 INNOVATION 26 AHERJ: COVID-19 IN THE STATE OF RJ 28 OHLA 2020 30 SPECIALTY 32 HOSPITAL MANAGEMENT 35 MANAGEMENT AND HEALTH 37 SYNAPSIS AWARD 40 COVER INTENSIVE THERAPY 46 AHECE 48 NATIONAL CONGRESS 06 DIGITAL HEALTH 50 OPINION 09 INTERVIEW 10 HOSPITAL INFECTIONS 52 IHF 17 GENERAL DATA PROTECTION REGULATION 54 PSYCHOSOCIAL ATTENTION 56 PALLIATIVE CARE 60 PATIENT EXPERIENCE 64 HEALTH TRENDS 68 HEALTHCARE BUSINESS 2020 70 BENCHMARKING HEALTH AWARD 2020 71 CARDIOLOGY 72 HOSPITALITY FORUM 74 STD / AIDS 76 TRIBUTE 78
EVENTS AND INDICATORS
HAPPENING AT THE CONGRESS 82 EVENTS CALENDAR 84 ECONOMIC INDEX WORKSHEET 86 NATIONAL CONGRESS
PRIVATE HOSPITALS AWAIT THE APPROVAL OF PROJECTS AIMED AT THE ECONOMIC RECOVERY OF THE SECTOR
By Felipe Nabuco [email protected]
Among the Draft Laws (PLs) that are being processed in the Chamber of Deputies, two, in particular, are expected to be on the agenda earlier this year. These are PLs 5.413/2019 and 2.894/2020, which enable, respectively, the amortization of tax debts for establishments in financial crisis and the granting of special lines of credit for small and medium-sized hospitals.
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If the year 2020 was marked by a scenario of The proposal in question is PL 5.413/2019, authored by unpredictability and total instability in the organization deputy Pedro Westphalen (PP-RS), which establishes of health systems around the world, that of 2021, the Program for the Recovery and Strengthening of however, already seems to make clear what the Hospital Establishments. The other is PL 2.894/2020, weather and challenges for the sector will be. For most by deputy Eduardo Costa (PTB-PA), which provides specialists, the biggest one will be to guarantee, with special credit lines for small and medium private limited resources, assistance coverage for a demand hospitals, with or without profit (PPMH). In the first, that has only been dampened over the last year. The the proposal is that hospitals pay off a debt with suspension of elective procedures delayed diagnoses the federal tax authorities, of something around R$ and aggravated cases that were already critical. If 58 billion, with services provided to the population, the queue for specialized procedures in the Unified through SUS. It would be like “killing three birds with Health System (SUS) was already immense, it will be one stone”. With the PL, small hospitals, so necessary something difficult to scale for the coming months. in small towns in the interior of the country, would not only keep their doors open, but would also have The problem, however, is not restricted to the issue of better cash conditions to provide better quality care. underfunding. To expand the offer, it is necessary to In addition, it would be possible to maintain thousands have availability of services. It is necessary to ensure of jobs and provide immense support to the SUS, that establishments and professionals are available, offering beds and surgeries at a critical time for health which in Brazil has been an arduous task. The crisis systems, such as the year 2021. that befalls the Brazilian hospital sector is old and only worsened in 2020, with the Covid-19 pandemic. In the “We are at the third meeting with the Ministry of last decade, the country has followed the loss of 560 Economy and government leaders, advancing the hospitals and more than 33.000 beds as a result of theme, trimming the edges and getting the Project the economic crisis and the mismatch in the model of right, so that the government can approve. In the last remuneration of establishments according to the SUS week, we had contact with [Health] Minister Pazuello table. It was precisely the lack of beds, during the peak and dealt with the repressed demand for procedures of the pandemic, that highlighted the main problem in that we will have for 2021. In addition to higher than the Brazilian health system. It is enough to note the expected demand, we also have increasing inflation unbridled rush, in the first months, of public managers in the Health Sector. Many establishments are being to structure beds in improvised hospitals to serve the significantly impacted and may close, exactly in a year population. in which we need more services”, explains Westphalen.
Facing such an adverse and challenging scenario His expectation is that PL 5.413/2019 will be put on for 2021, the approval of two Draft Laws (PLs) that the agenda at the beginning of 2021. “The Project are being processed in the National Congress may is extremely important, and already has favorable contribute decisively to the problem of scarcity of opinions from the Union’s control bodies and the inputs for SUS, in a year in which the demand will Ministry of Economy itself. We are even asking for be high, as well as resolving the financial issue of urgency to vote”, adds the parliamentarian. hospitals regarding a historic debt they owe to the federal tax authorities, which, according to the author He emphasizes that, although it is not a definitive of one of the PLs, “could only be paid in services”. solution to the problem of hospital debts with the federal tax authorities, the PL opens an important path
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for the reconstruction of the current remuneration to the population in this period of health emergency. model. “It is also necessary to review the model of The hospital sector, as we know, has been severely relationships between hospitals and municipal, state affected, and, like all companies in the country, it also and federal governments. We need to find a new faces financial problems in its activities. We hope that, remuneration model and focus on preventive actions with its analysis and approval, the Project can help and procedures that prevent hospitalization. Hospitals the sector to go through this very difficult period”, need to be paid according to the quality of the services highlights Costa. they provide. I believe that, with a lot of dialogue, we will find a model that is good for the citizens, for He explains that this credit line will be granted by the the governments and for the hospitals themselves”, official federal financial institutions participating in the emphasizes Westphalen. PPMH, which will offer an annual interest rate of 3%, a term of 48 months for payment, and a six-month grace SPECIAL CREDIT LINES period for payment to begin. “Those hospitals that demonstrate expansion of formal employment and Also with the expectation that PL 2.894/2020, by investments by at least 20% in the first six months of Congressman Eduardo Costa (PTB-PA), will be placed the financing contract under the PPMH, will have their on the agenda in the first months of 2021, if approved, interest rate on financing in the Program reduced by half.” it may help small and medium-sized hospitals, which face serious financial difficulties. To make the PPMH feasible, the Federal Government must transfer approximately R$ 3 billion to the official The PL establishes financial support for hospitals, federal financial institutions participating in the through the creation of a special credit line and the Program. “My expectation is that the Project can be reduction of interest charges on financing. “This appreciated right after the resumption of legislative proposal aims to finance working capital, payroll and work, in February 2021. As the Thematic Commissions investments, especially in hospitalization beds and are still unable to return to activities, all projects Intensive Care Units (ICUs), to ensure better service in this period are sent directly for consideration in plenary, after agreement. The urgent request for the Project was presented and is being supported by the leaders of the benches in the Chamber of Deputies. The speed of the procedure was hindered by the electoral calendar and the pandemic”, concludes the author of the Project.
8 | OPINION VISÃO HOSPITALAR MAGAZINE
WHAT DOES HEALTH EXPECT FROM NEW GOVERNMENTS?*
Every four years, the hope of having a stronger Health a priority at all times, not only in times of pandemic. In Sector that fully serves the population is the feeling Brazil, however, we are more concerned with the means that is always renewed. After all, this is a wish of the than with the population’s access to the services that society that existed even before the pandemic, of should be provided. We have to follow the paths that are course. From this perspective, municipal elections working. Studies and research are fundamental to outline tend to be under the citizen’s most attentive eye, and the direction we want. We are experiencing a delicate the question always returns: “What to expect from the moment in the Health Sector, and the chain is worn out. new government?”. It is a fact that the new government will have to face fundamental questions, such as those We have to put our efforts on prevention to lower related to investments in health. treatment costs. In fact, it is necessary to maintain a continuous agenda of discussions on possible issues Brazil has one of the largest private health systems solutions in the Health Sector. They must be thought in the world. The country spends more than R$ 609 out and tested. Business and government must walk billion per year on health, which represents about together in search of results to serve the population. 9.3% of the Gross Domestic Product (GDP). And the Therefore, we leave a double question to the incoming private sector is responsible for the largest share, managers: how will they start the journey and which 5.4%, while public spending accounts for 3.9% path will they take? The most viable option would be of GDP. Some health practices in Brazil need to be to move in the direction of what needs to be done reviewed. The political party doesn’t matter; what as urgently as possible, so that the sector does not is essential is to think and plan, so that everyone’s collapse, if we want to save municipalities from even interests are covered. worse situations than the current ones.
In an increasingly digital world, technology will always * Article originally published in the Diário do Poder-DF, be a great ally. Ways of reducing expenses through on November, 26th 2020. programs and initiatives, such as joint purchases of high-cost inputs, broader management of treatment for chronic patients, focus on prevention, may be part Some health practices in Brazil need to be of the public-private partnership. We need greater reviewed. The political party doesn't matter; collaboration between government, service providers what is essential is to think and plan, so that and patients. The implementation of models that configure a relationship between result and payment everyone's interests are covered. should be among the points to be put into practice.
Telemedicine is another point that should remain ADELVÂNIO FRANCISCO MORATO highlighted, as it will be an adequate way to reduce President of the Brazilian Hospitals distances and care costs. Patients who had to travel Federation (FBH). to large centers started to be treated and diagnosed remotely. Addressing access to health care should be
| 9 INTERVIEW
“FOR SURE, WE WILL HAVE A ‘WAVE’ OF UNPREDICTABLE PROPORTIONS, RELATED TO EVERYTHING LEFT TO DO IN 2020” WILAMES FREIRE BEZERRA PRESIDENT OF THE NATIONAL By Felipe Nabuco COUNCIL OF MUNICIPAL HEALTH SECRETARIES [email protected] (CONASEMS)
In January 2021, a new cycle of municipal for the execution of health actions and services, management begins throughout Brazil. Thousands approximately R$ 124 billion. In other words, 2.4% of mayors, and with them, their respective municipal more than was allocated in 2020. However, so far, health secretaries, will face, already in their first there is no forecast of resources to be reserved to month of administration, a complex scenario of the face the pandemic, which, in 2020, exceeded the Covid-19 pandemic “return” across the country, which figures of R$ 44 billion, and will certainly continue to many have already called “second wave”. Faced with be needed in 2021. so many exchanges in the Municipal Executives, the discontinuity of the assistance services is not what With a forecast of few cash resources and a demand most concerns the National Council of Municipal that has increased exponentially in the last year, as a Health Secretariats (Conasems). For Wilames Freire result of the impounding of care and the worsening Bezerra, president of the entity, what has taken the of chronic cases, the Municipal Health Secretariats sleep of health managers across the country are the will face an even more challenging scenario than the forecasts, not very encouraging, of the financing of beginning of the pandemic. “For sure, we will have the Unified Health System (SUS) for 2021. a ‘wave’ of unpredictable proportions, related to everything that was left to do in 2020: appointments The Budget Law Project, presented at the National that are no longer carried out, application of vaccines, Congress, grants the Ministry of Health, in 2021, control and care actions for chronic patients, surgeries
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Wilames Freire Bezerra – The panorama of the pandemic, in the world and in Brazil, shows that we will live with Covid-19 for a long time. And, for sure, we will have a “wave” of unpredictable proportions, related to everything that was left to do in 2020. Services that are no longer performed, application of vaccines, control and care actions for chronic patients, surgeries and elective procedures ... in short, all non-Covid situations that have been postponed or canceled. In conclusion, the unpredictable scenarios will continue in 2021. Our main concern is precisely this situation that we have already experienced and that requires the need to reorganize the Health and elective procedures… in short, all non-Covid Care Network, to live together, for a long period of situations that have been postponed or canceled”, time, between Covid and non-Covid cases. Since comments Freire. August 2020, we have started to prepare a process to support new municipal health managers for According to him, among the main challenges is the municipal management that begins in January 2021. organization of specialized assistance. “Considering the historical data of the last four years, until VISÃO HOSPITALAR – How has this help been? September 2020, there was a lag of more than 770 million outpatient and hospital procedures, with the Wilames Freire Bezerra – It is important to emphasize forecast that this number will exceed 1 billion in 2021. that, while the actions initiated and under We are talking about health promotion and prevention development cannot be discontinued, the new actions, diagnostic, clinical, surgical procedures, municipal management brings new priorities, new transplants, medications, orthoses, prostheses and perspectives on problems and solutions, and this has complementary health care actions”, he explains. been positive over time. In this way, we are developing a set of initiatives, projects and actions that aim to The retraction of federal resources for Primary strengthen what we call the “NIN of Management”, and Health Care (PHC) is another strong concern. “This to develop the Health Care Network, implementing is one of the most important areas of attention to governance and interfederative management the population, the increase in resources planned mechanisms. This means: qualifying the municipal for 2021 is not enough to support the increase, planning process, organizing the Municipal Health constitutionally established, for health workers. Conference in 2021, strengthening social control and Conasems presented to the National Congress the qualifying the budgetary, financial and accounting need to complement more than R$ 1 billion so that management of the Municipal Health Funds. At the there is no loss of service to citizens.” Check out the same time, strengthening health care processes, complete interview with the president of Conasems. reinforcing the role of PHC as care coordinator and organizer of the Network. For this, Conasems relies VISÃO HOSPITALAR – In 2021, a new cycle of on their Network, the Council of Municipal Health municipal management begins throughout Brazil. Secretariats (Cosems), the network of regional The pandemic scenario shows that the situation supporters, coordinated and integrated projects and may worsen in the coming months, with the “second initiatives, as well as communication channels with wave”. Facing so many changes in the commands of each municipal manager in the country. the Municipal Health Secretariats, what is the main concern at this moment? How has Conasems acted to VISÃO HOSPITALAR – Industry experts have pointed contribute to these transitions? to SUS financing as the biggest challenge for 2021.
| 11 INTERVIEW
This is basically due to the reflexes of the pandemic, more than R$ 1 billion so that there is no loss of which prevented visits, delayed diagnoses and service to citizens. Another concern is the decrease worsened the situation of patients who were already in federal resources reserved for SUS. In the last serious. In addition to the exponential increase in few years, the municipalities have contributed to demand, municipal and state administrations will the system values much higher than the required not count on the budget increase they had in 2020 constitutional minimum, resources that, in one year, to combat the pandemic. How do you evaluate the even represent the total collected in Property Tax and economic health scenario for 2021? Urban Territory (IPTU). Still in relation to the decrease in federal resources, the retraction in investments in Wilames Freire Bezerra – In 2020, the Ministry of the system is noteworthy. Year by year, the amounts Health’s budget received an investment of more than reserved for expanding and strengthening the R$ 44 billion. This amount was used to face the public installed capacity of the system have decreased health emergency of international importance due to or migrated to parliamentary amendments. It is the new coronavirus. Nearly half of this amount was important to have more resources directed to the transferred to the municipalities; however, it is worth structuring of care networks, formed in the health mentioning that the amount of extraordinary credits regions, in order to guarantee the integral and reserved to SUS represents only 7.3% of the more universal care of SUS. than R$ 600 billion allocated by the Union to confront Covid-19. The Budget Law Project, presented at the VISÃO HOSPITALAR – In general, how do you evaluate National Congress, grants the Ministry of Health, the performance of the Municipal Secretariats in 2021, for the execution of health actions and while facing the coronavirus pandemic? How has services, about R$ 124 billion, or 2.4% more than it Conasems been helping municipalities throughout was destined in 2020. Thus, in addition to concerns the pandemic? about the lack of resources earmarked for the necessary health actions to combat the pandemic, Wilames Freire Bezerra – We evaluated it as positive, which, in fact, will not end on December 31st, 2020, given the scenario of extreme uncertainty and there are other, but no less important, concerns. politicization. Conasems helped as the protagonist of numerous demands, such as the insistence on VISÃO HOSPITALAR – Could you list these concerns? improving the case definition criteria, which was prepared in July, together with the Ministry of Health, Wilames Freire Bezerra – Actions aimed at outpatient and resulted in the Covid-19 Surveillance Guide and and hospital care not performed due to the pandemic its revisions. We also made an unceasing defense of are one of them. Considering the historical data of expanding RT PCR tests for primary care; we conduct the last four years, until September 2020, there was a virtual training on the importance and how to carry lag of more than 770 million outpatient and hospital out the monitoring and isolation of people with procedures, with the forecast that this number will Covid, aiming at interrupting the transmission; we exceed 1 billion in 2021. We are talking about health created the Conasems Health Surveillance Group, promotion and prevention actions, procedures for with representation from all Cosems and a weekly diagnostic, clinical, surgical, transplants, medications, meeting to provide more effective technical support orthoses, prostheses and complementary health care to municipalities in relation to tackling the pandemic. actions. The retraction of federal resources for PHC is another strong concern. This is one of the most VISÃO HOSPITALAR – One of the emergency measures important areas of attention to the population, the taken in 2020, which does not appear to be repeated increase in resources planned for the year 2021 is in 2021 in many places, concerns the structuring not enough to support the increase, constitutionally of field hospitals to serve the population. What is established, for health workers. Conasems presented Conasems’ assessment of makeshift hospitals? Was to the National Congress the need to supplement it an assertive measure? Did they leave any legacy?
12 | VISÃO HOSPITALAR MAGAZINE WILAMES FREIRE BEZERRA PRESIDENT OF THE NATIONAL COUNCIL OF MUNICIPAL HEALTH SECRETARIATS (CONASEMS) VISÃO HOSPITALAR – One of the themes that has occupied the sector’s agenda concerns the debate about the vaccine and the population’s vaccination process. What is the main concern of Conasems in relation to the theme? Is there any risk that the immunizer will not reach all municipalities?
Wilames Freire Bezerra – Our main concern is with the operationalization of the vaccination plan. We know and have a lot of competence in this process, since we apply approximately 300 million doses annually in our 48.000 Basic Health Units (UBS). Regarding Covid-19, we won’t have vaccines for everyone. So, some questions concern us: inputs, such as syringe and needle (who will provide these inputs to the municipalities?); precarious and very inconsistent information system; timely communication (as we will need to be accurate in informing vaccination group priorities); safety in relation to transport and during vaccination at the UBS. There is also great concern about some vaccines against coronavirus, as our cold chain does not have extremely low negative temperatures. Vaccines will reach all Brazilian municipalities in accordance with the Constitution Wilames Freire Bezerra – The modeling of the and the basic principles of SUS. Attention Network to fight the pandemic happened as we got to know the disease and its history. Examples of this are diverse, and not just makeshift hospitals. The decision to implement hospitals came “The increase in resources from the analysis of the situation in each Federation Unit, made by states and municipalities and included planned for the year 2021 is not in the state contingency plans. And so it should be, enough to support the increase, because it is the municipalities and states that have the management of the Care Network and know their constitutionally established, capacity and qualification for health care, as well as for health workers. Conasems their capacity in managing the clinic. A lot of makeshift hospitals and other equipment, such as service presented to the National centers, had and continue to play a fundamental Congress the need to complement role in composing and expanding the health system’s capacity to respond to the health needs more than R$ 1 billion so that of the population. We can also point out the great there is no loss of service to development of telehealth actions that occurred. In addition to being necessary: the training of health citizens.” - Wilames Freire Bezerra, professionals; the acquisition of equipment; and the president of Conasems logistics structure for the care that has occurred and that remains. These are permanent actions to make our health system better.
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BUILDING THE ‘NEW NORMAL’: harnessing transformations from the covid-19 pandemic.
BUILDING A ‘NEW NORMAL’
The COVID-19 pandemic has united healthcare systems across the world with a common purpose: ensuring capacity to help those who have been affected by coronavirus and minimising its impact on the health and well-being of people and communities.
Acting as a radical disruptor to the ‘normal’ way of doing things, the COVID-19 pandemic has accelerated transformations within healthcare at an unprecedented pace. Never have hospitals and healthcare organisations been forced to change so radically in such a short period of time. We have seen critical care services being run virtually using digital technologies; organisations rapidly up-skilling staff and mobilising volunteer carers at scale; the breaking- down of workplace silos to ensure that patients receive integrated care and creative architectural solutions to manage flows of people in and out of hospitals as part of infection control.
These changes have, in many instances, incorporated a fundamental redesign of services, with profound implications for both staff and patients. Although the prime catalyst for changes has been the urgent need for COVID-19 infection control, it is notable that some of these have long been priorities for healthcare systems, on which there had been limited progress prior to the pandemic. The pandemic has provided
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a new context that allowed previously long-held patients prior to hospital visits and triage assessment; assumptions and norms about how care should be in the routine provision of care at home, and also delivered to be urgently re-examined and, if necessary, remotely monitoring patients by off-site specialists. changed. To support its community to realise the benefits of these changes, the International Hospital Synchronous telehealth (the use of audio-visual Federation established the IHF ‘Beyond COVID-19’ technology enables clinicians and patients to Task Force. communicate in real-time) has become a particularly valuable option for providing continuity in care and Comprising IHF members and strategic partners from treatment during the COVID-19 pandemic. Telehealth across the international healthcare community, the enables clinicians to provide routine consultations Task Force was charged with supporting hospitals via video and monitor clinical signs of certain to adopt practices realised during the COVID-19 conditions remotely (i.e. blood pressure) through pandemic, which have beneficially transformed healthcare ‘wearables’. This minimises disruptions to healthcare services and so should be sustained patients’ care plans and treatment and reduces the in the future. Drawing directly of the experiences risk of coronavirus contraction by eliminating travel of the IHF ‘Beyond COVID-19’ Task Force and their to a clinical setting for care – something particularly networks, today the IHF publishes a new report beneficial for vulnerable patient groups, such as the offering insights into how hospitals can embrace elderly or those with comorbidities. new ways of delivering healthcare: ‘Building the ‘New Normal’: Harnessing transformative practices from the Synchronous telehealth is also well-positioned to COVID-19 pandemic’ (available here). A selection of help health systems combat professional staffing detailed case studies accompanies this publication, shortages. Globally, the coronavirus pandemic has offering further depth to the transformative changes exacerbated shortfalls in the healthcare workforce – in included the report. particular, a lack of specialist staff to work in intensive care units (ICU). Leveraging telehealth technologies IN WHAT WAYS HAVE HOSPITALS enables hospitals to optimise their clinical capacities. TRANSFORMED? By using remote patient monitoring, one specialist can monitor multiple patients at a time, across different As part of its charge, the Task Force identified potential sites, so clinicians spend less time moving physically areas of transformation across three different between patients and thus can increase the number themes: delivery and access; supply, logistics, and of people who can be treated. In turn, it reduces wait infrastructure; people. Outlined below are a flavour times for appointments, and, at least partially, offsets of transformations realised during the COVID-19 workforce shortages caused by COVID-19. pandemic. Some of these changes are not new ideas but the coronavirus crisis acted as a catalyst for their A QUIET REVOLUTION IN HOSPITAL widespread acceleration and adoption. DESIGN
Harnessing digital technology to provide care Supply, logistics and infrastructure are critical dimensions of a successfully functioning hospital. In relation to delivery and access, one of the biggest Learning from transformations made during the ‘service shifts’ in the health sector was widespread COVID-19, hospitals should move away from ‘fixed’ adoption of telehealth and telemedicine. Given the paradigms of supply, logistics and infrastructure to high risk of transmission of coronavirus through person- more adaptive models, which can be flexed to suit a to-person contact, the pandemic has accelerated an hospital’s needs more efficiently. unprecedented expansion in telehealth around the world. The Task Force found that telehealth models Moreover, hospitals will have to examine how their have been implemented in the large-scale screening of physical environments and technical infrastructures can
| 15 IHF TASK FORCE
be adapted to enable greater flexibility in responding The need for social distancing to prevent transmission to exceptional healthcare situations in the future. In of coronavirus is well understood, but a humane relation to supply and infrastructure, the IHF Task Force approach to visiting policies in hospitals and care found that healthcare organisations and hospitals took homes need not be incompatible with an effective three principal approaches to make lasting changes to pandemic response. Spending time in the hospital their environments in response to COVID-19: can be an anxious experience, even more so during a challenging pandemic: communication is vital to the • Reorganisation of the health service facility itself: mental well-being of patients. During the COVID-19 crisis, many hospitals have initiated ‘virtual visiting’ » o To better accommodate COVID-19 patients for the first time – using iPads and video conferencing within a hospital, spatial and organisational applications to combat the loneliness and social adaptations have been implemented, including isolation felt by patients by connecting them with the reorganisation of internal ‘foot traffic’ their families and carers. routes and flows to separate those infected by coronavirus from those without the virus. MOVING BEYOND COVID-19 • Creation of emergency structures: As hospitals enter their recovery phase post-COVID-19 and start to address the backlog of care and unmet » o In certain cases, hospitals installed needs caused by the pandemic, they will need to prefabricated modules (e.g. shipping containers) maintain openness to radical innovation and learn which had been redesigned and modified from what made such a response possible. The ability to respond to the needs of the COVID-19 of healthcare systems to respond to and recover emergency. from this unprecedented crisis will vary significantly: • Conversion of existing non-health structures: the need to improvise and adapt will continue for the foreseeable future; ensuring that when the next » o Some hospitals dedicated entire buildings public health crisis hits, hospitals are prepared. At to COVID-19 patient care and so redeveloped the International Hospital Federation, we remain non-health areas within their campuses (such committed to supporting our global community in as staff gyms and storage units) which were meeting this challenge. either underused or abandoned.
COMPASSIONATE CARE IN A CRISIS
Many hospitals have put in place strict control measures to protect patients, families and staff from the risk of coronavirus infection. With these strict restrictions, relatives and carers of patients can no longer make in-person visits, and so healthcare workers become the primary link between patients and their families. Moreover, for hospital staff, especially those working within intensive care units (ICUs), visiting restrictions ALEXANDRA GRAY created greater difficulties to keep families and carers is the IHF Secretariat’s Programme Manager informed about a patient’s progress, discuss treatment and held strategic oversight for the work of its ‘Beyond Covid-19’ Task Force. Currently, Alexandra options, etc. and to ensure that those at the ‘end of is leading the development of the Federation’s life’ have comfort from relatives. Women Executives’ Forum and climate change activities in healthcare.
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FBH BECOMES THE ONLY BRAZILIAN REPRESENTATIVE on the Governing Council of the International Hospital Federation
By Felipe Nabuco [email protected]
The president of the Brazilian Hospitals Federation FAREWELL (FBH), Adelvânio Francisco Morato, is the newest Brazilian representative on the Government Council Francisco Balestrin’s mandate as President of the IHF, of the International Hospital Federation (IHF), the in the years 2018 and 2019, was highly praised by main representative entity of the global hospital members of the Federation Council. In recognition sector. Morato takes over the position left by Francisco of his excellent work, Balestrin received the title of Balestrin, who, during the last eight years, defended Honorary Lifetime Member of the institution. the position of Brazilian establishments in the decisions taken by the IHF. The election of the new “I had the honor of being president for two years and members of the Government Council took place on presiding over two world hospital congresses (in 2018, November 12th. in Australia, and in 2019, in Oman). I am very happy for this feeling of accomplishment and also grateful to all With the election of Morato, the FBH, as of 2021, the presidents I served with,” said Balestrin. becomes the only representative member of Brazil in the institution, with the right to vote in the decisions IHF made in the General Assembly. With a seat on the Council, Adelvânio Morato will have the mission The International Hospital Federation (IHF) is an of continuing the excellent work carried out by his international non-profit and non-governmental compatriot, Francisco Balestrin, taking the Brazilian organization, created in 1929 to represent hospitals experience to contribute to the debates and decisions and health associations worldwide. Its mission is to to be taken by the IHF. offer a platform that allows the exchange of knowledge and strategic experiences, as well as opportunities for “I am honored to compose this group of great references international collaborations with different actors in for the global hospital sector. We will continue the Health Sector. working to bring our experiences and our learning to the debates, as well as to bring contributions that With a seat on the Council, allow the Brazilian sector to evolve”, emphasizes the president of FBH. Adelvânio Morato will have the mission of continuing the excellent At his first meeting at the Council, Morato participated work carried out by his compatriot, in discussions on the entity’s agenda until the rest Francisco Balestrin, taking the of the year, as well as for the beginning of 2021. The meeting also provided a moment for new elected Brazilian experience to contribute members to get to know each other and become to the debates and decisions to be familiar with the plans and goals listed for next year. taken by the IHF.
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Feira Internacional de Artigos e EquipamenFeira Internacionaltos Médic deos, Artigos Hospit alae res, deEquipamen Laboratóriostos Médie Reabilicos, tHospiaçãotalares, de Laboratórios e Reabilitação
SSÃÃOO P PAUAULLOO | | BRASBRAS IILL 4-74-7 DE DE MAIO MAIO 20212021 Member of Member of
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DDASAS 13h 13h às às 20h 20h - - EXPO EXPO CENTER CENTER NORTENORTE ASAS MELHORES MELHORES SOLUÇÕES SOLUÇÕES PARA PARA OSOS SETORESSETORES PÚBLICOPÚBLICO E E PRIVADO. PRIVADO. PavilhõesPavilhões internacionais internacionais | + | 300+ 300 expositores expositores | Palestras| Palestras de de gestão gestão e inovaçãoe inovação na nasaúde saúde | Ferramenta | Ferramenta de de matchmaking matchmaking para para contatos contatos e e reuniões reuniões
GarantaGaranta o seu o seu espaço espaço na na edição edição brasileira brasileira da da MEDICA! MEDICA! [email protected] | medicalfair-brasil.com.br Vendas: [email protected] | medicalfair-brasil.com.br Vendas: +55 11 2365-4336 +55 11 2365-4336
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Revistas_visao_hospitalar_FBH_20,5 x 27,5._2021.pdf 1 20/08/20 17:22:39
Feira Internacional de Artigos e EquipamenFeira Internacionaltos Médic deos, Artigos Hospit alae res, DATA PROTECTION VISÃO HOSPITALAR MAGAZINE deEquipamen Laboratóriostos Médie Reabilicos, tHospiaçãotalares, de Laboratórios e Reabilitação
SSÃÃOO P PAUAULLOO | | BRASBRAS IILL 4-74-7 DE DE MAIO MAIO 20212021 ADEQUACY TO THE NEW Member of Member of REGULATION: HAVE YOU ALREADY STARTED?
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DDASAS 13h 13h às às 20h 20h - - EXPO EXPO CENTER CENTER NORTENORTE ASAS MELHORES MELHORES SOLUÇÕES SOLUÇÕES PARA PARA OSOS SETORESSETORES The General Data Protection Regulation (GDPR) is strict inspection. This is because the manipulated already in force. All health institutions, whether clinical data, treated in health, are considered sensitive by PÚBLICOPÚBLICO E E PRIVADO. PRIVADO. or laboratories, regardless of size or billing, need to the Regulation itself (Art. 11 of the GDPR), since they PavilhõesPavilhões internacionais internacionais | + | 300+ 300 expositores expositores | Palestras| Palestras de de gestão gestão adapt and it takes time, even months; it is not just a relate to people’s life situation, such as diagnosis and simple privacy policy or software installation because treatment of all kinds of diseases that could have a e inovaçãoe inovação na nasaúde saúde | Ferramenta | Ferramenta de de matchmaking matchmaking para para contatos contatos e e reuniões reuniões it involves, above all, a lot of training of the teams and huge negative impact on their lives, if these data leak. a change of culture in the handling of the data of the The handling and access to the patient’s medical record GarantaGaranta o seu o seu espaço espaço na na edição edição brasileira brasileira da da MEDICA! MEDICA! patients and individuals, including the employees while hospitalized, for example, must be adapted to [email protected] | medicalfair-brasil.com.br Vendas: themselves. the new dictates of the Regulation. [email protected] | medicalfair-brasil.com.br Vendas: +55 11 2365-4336 +55 11 2365-4336 If, on the one hand, GDPR is a huge social advance, The GDPR “is here to stay” as it is similar to the creating countless benefits for the entire community, Consumer Protection Code. The main inspector of this including hospital managers themselves as individuals, Regulation is the data owners themselves, that is, all on the other hand, the sectors linked to health, without of us, in this case, employees of health institutions, Conheça a MEDICALtalks Live. Conheça a MEDICALtalks Live. exception, were extremely impacted and will undergo patients or any individual. In other words, any citizen Conteúdos exclusivos da Medical Fair Brasil. MEDICALtalks Conteúdos exclusivos da Medical Fair Brasil. MEDICALtalks Acesse nosso canal no YouTube. Live Acesse nosso canal no YouTube. Medical Fair Brasil | 19 Live Medical Fair Brasil DATA PROTECTION
can apply to any legal entity (and, if it is in the health area, the amount of information is greater, as it has sensitive data, such as biometric data, religion, medical records, exams, etc.) what data the health institution has in its records, and also require that it be informed what was done with them and with whom they were shared, for example.
For this reason, health plans are already requesting information on the adequacy to the GDPR, and soon, it will be the Ministry of Health’s turn (Unified Health System - SUS), in an accelerated domino effect. Finally, if the establishment does not provide the information, leaves doubts about the veracity of the information, or even leaves it incomplete, the data subject may report it to the State Department of Consumer Protection and Defense (Procon) or seek compensation for moral damages in the Special Civil Court (JEC) – or both -, being also possible the intervention of the National Data Protection Authority (ANPD), with subsequent imposition of sanctions if irregularities are found. In short, adapting to the GDPR is not just a legal requirement. The market itself will demand, as it is already demanding from each other, and those who do not meet the criteria will no longer be able to act given BRUNO FEROLA the countless processes to which they will be subject. Partner of P&B Compliance and Compliance Lawyer. Has expertise in the areas of anti- corruption and criminal compliance, M&A, Aware of this challenging scenario, the Brazilian contracts and civil legislation and in projects Hospitals Federation (FBH) has been searching for that involve CGU, MPF, CADE, DOJ and SEC, investigations of corporate fraud, misappropriation alternatives and solutions for over a year, aiming of assets, anti-corruption due diligence, to assist all its associates, without exception, in the implementation of anti-fraud and anti-corruption compliance programs and technology. fulfillment of this new legal requirement, arising from that, the GDPR partnership between FBH and P&B Compliance. Two were the Federation’s main LUCAS PAGLIA requirements to make this joint work possible: that Founding partner of P&B Compliance and lawyer specialized in Risk Management, Mitigation and P&B was committed to creating a work plan that could Mapping, with extensive experience consolidated reach all its associates, in any region of Brazil; and that in contracts in the corporate environment, as well as participation in outstanding projects in conditions and prices accessible to even the smallest multinational companies. member were created, in terms of revenue. And so it was done: we are currently able to meet demands anywhere in Brazil. Therefore, the market will not RENATO BREUNIG accept inertia in 2021. We must start! Founding partner of P&B Compliance and lawyer certified by Behavior Brazil in Implementation of Anti-Bribery Policies (ISO 37001), with extensive experience and performance in management services and hospital legal guidance.
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WE REINVENT OURSELVES AND DEMONSTRATE PIONEERING AND BOLDNESS, assuming that getting ahead is in our DNA
We will enter 2021 prepared, with connection project between suppliers and buyers. In the week that the event would take place, we a lot of optimism, seriousness and presented a marathon of content geared to the sector. serenity to face new challenges. In total, the event, the first in the segment in virtual format, brought together more than 5.000 people and We are ready to make the biggest maintained its high level of quality and content. But we Hospitalar in our history! were not satisfied with what we managed to generate from relationship and business opportunities, two very strong pillars in our physical event. To solve this deficiency, we have improved processes and are The Covid-19 pandemic brought a new reality to the looking for edge technology. We started to use an 2020 year. We were growing. We were safe and ready intelligent platform, which would help us to maximize for the 27th edition of Hospitalar, which would be the the use of what digital has the best: data. biggest ever. But, what could be something disastrous, I believe it has become something of important value We continue the year committed to improving virtual for the Health Sector. We had to learn fast, reinvent experiences. In June, we launched an unprecedented ourselves and take risks. There were no references on event, Omnia Health Live (OHL), developed in how to deliver events with digital scale. partnership with the other 13 major health events held by the company around the world. A proposal The 27th edition of Hospitalar will take place between that made total sense, since many of our exhibitors are May 18th and 21st, 2021. The expectation is for a the same. There were 70 lives, with the participation hybrid event, bringing together our experience acquired of 200 speakers for almost 25 thousand visitors, the in 2020, with virtual initiatives, with the one already majority of whom were Brazilian viewers. This meeting consecrated for 26 years with the face-to-face version. To was attended by more than 1.400 exhibitors, with prepare, there were hours of planning and reorganization more than 11.000 products. in order to ensure the health of the participants. In this 2020, we adapted to digital initiatives. The content part of the event was a success, with high caliber speakers, such as the director of the World Our first experience was to mark May, the month of Health Organization (WHO), Tedros Adhanom. At this Hospitalar, with the Hospitalar.com. We developed a event, already running on our new matchmaking
| 21 HOSPITALAR 2021
platform, we had an important breakthrough in the international companies and 2.925 visitors from relationship and business pillars, but we are still across the continent. During the week of activities, not completely satisfied. A very positive factor in current issues were dealt with, such as disruption and this journey was the engagement of many of our the new movement to face the reality imposed from exhibitors, willing to build this new experience with Covid-19. New proposals were adopted from this us. In addition, shortly after OHL, Informa had already action, reminding the world of the need for experience held almost a hundred digital events around the world, and agility to adapt to the post-Covid-19 era. And with a mountain of learning that started to be shared finally, we come to a robust number of connections with us. and business meetings between exhibitors and participants. In September, we had one more challenge, the Healthcare Innovation Show (HIS), but we were already We will enter 2021 prepared, with a lot of optimism, more confident about the changes we needed to seriousness and serenity to face new challenges. We make to get where we needed to. Lasting three days, are ready to make the biggest Hospitalar in our history! completely online, 150 speakers were present on five The expertise acquired in the events of 2020 and over stages, with topics ranging from customer service to the other years allows that, regardless of the modality telemedicine. In terms of innovations, we had rooms in which the event will be promoted, it will maintain in which groups of up to 50 participants could open the standard of excellence, Hospitalar’s trademark. the cameras and participate in thematic discussions, Our expectation is that the new directions will be stimulated by our moderators. In addition, several implemented by security in relation to Covid-19, as startups presented health products and services with we are ready to adapt to the imposed needs, with the international prominence. On the occasion, we had the certainty that we will offer the best that the market opportunity to deliver the Health References Award, needs, seeks and deserves. which referred to the best practices against Covid-19.
We ended the 2020 year with yet another high- level international event, in partnership with EDUARDO BARROS FIME and ExpoMed, from the United States and Business Director at Informa Markets, promoter of the Hospitalar fair. Mexico, respectively: Omnia Health Live Americas (OHLA), which received more than 900 national and
Our digital results in 2020: » 17 webinars; » 4 virtual events; » 760 speakers; » 240 hours of content; » 2.800 sponsors from 60 countries.
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| 23 REFERENCE HOSPITAL
UNIMED VOLTA REDONDA Hospital is a reference in high complexity and humanization
More than services to patients, society as a whole, since 2009. Through UWC, patient care is not limited to drugs and tests; goes much the hospital offers a unique further, with an investment in differentiated service. care experience. More than 9.5 Celebrating birthdays, wedding ceremonies, graduation ceremonies and commemorative dates million attendances were made celebrations are some moments promoted by the in ten years hospital to help patients’ recovery be even faster and make treatments less painful. “Our hospital is With ten years of activity, the Unimed Volta Redonda a reference for the entire region in terms of quality, Hospital has become not only one of the most safety, comfort and humanization. The Unimed Way important Medicine centers in the South of Rio of Caring that is only ours and that has become an de Janeiro, but also consolidated the region as a important competitive differential, valuing care in reference in highly complex procedures. The hospital all relationships. For this, we continuously invest in is one of four across the state with authorization for the development of our members and collaborators. bone marrow transplants and the only one outside That’s what we believe in”, says the president of the the metropolitan region. In 2020 alone, 14 transplants Cooperative, Dr. Luiz Paulo Tostes Coimbra, who has were performed. Over these ten years, more than been in charge of the institution for 18 years. 9.5 million consultations were performed, with more than 955.000 imaging tests, 79.000 surgeries and 7.3 And it is this unique experience that UWC offers that million laboratory tests. is making all the difference for patients seen during the pandemic. Due to the disease, they cannot receive More than services to patients, the hospital offers a face-to-face visits. Thus, videos were introduced unique care experience. The words that express this to employees who provide care, digital visits and culture are kindness, respect and competence. The hospitality actions to further humanize the service Unimed Way of Caring (UWC) is the commitment and reduce the loneliness feeling of patients admitted assumed in the relations with the cooperative doctor, by Covid-19. the employee, the customer, the supplier and the
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EXPANSION OF SERVICE “Our hospital is a reference for The hospital inaugurated the building, with 14.400 m², which increases its service capacity by 82%. the entire region in terms of The investment of R$ 66 million should create 300 quality, safety, comfort and job opportunities for doctors, nursing technicians, nurses, pharmacy technicians, hospitality assistants, humanization. The Unimed Way medication handling technicians, physiotherapists and psychologists, in addition to the indirect jobs of Caring that is only ours and of the administrative team. With the expansion, the that has become an important unit goes from 145 to 265 beds. Among the main services offered in the expansion building are the competitive differential, valuing expansion of the Oncology Center, Adult and Pediatric Onco-hematology, the Infusion and Special Medicines care in all relationships.” Center, the Bone Marrow Transplant Center, and the Intensive Care Unit (ICU) Adult, Neonatal and Pediatric, Dr. Luiz Paulo Tostes Coimbra, Radiotherapy and PET-CT Digital. president of Unimed Volta Redonda
LUIZ PAULO TOSTES COIMBRA president of Unimed Volta Redonda
| 25 INNOVATION
WHAT IS THE FUTURE OF HEALTH POST-PANDEMIC? Digital innovation responds
The Covid-19 pandemic hit us. Putting aside all health throughout the patient’s journey: apart from individual and humanitarian issues, it has changed the way we data (such as genetic, behavioral and physiological), relate to the work, people, products and services we we will also have data on social interactions, the consume. It brought us countless losses, at the same environment and the ecosystem as a whole. time that it is seen as the driving force of innovations, such as the adoption of home office initiative and With that, we will put aside medical records to medical consultation. Undeniable advances and administer personal application programming interface changes in behavior, yes. But we did not have a (APIs). If we need a consultation or an emergency structural change in the way we relate to health; we service, we will give the clinical staff access to our APIs took only a first step, a glimpse of some future trends and that’s it. that will develop in the next decade. The symptom analysis will become a data analysis: Throughout my career as a specialist in innovation before we complain about “sore throat” or and the work I have been doing in the Supplementary “indisposition”, we will have our personal database Health area, I have been able to observe some being analyzed to find out what, in fact, is wrong, if movements that indicate the future scenario in which conditions exist clinically or somatic symptoms, so we will live. In the next ten years, we will see health that we tackle the root of the problem. services developing under three aspects (or trends). We will have our data organized in a physiological dashboard, a personal big data. But then, the question 1. INFORMATION AT THE TIP OF arises: what to do with this data? OUR FINGERS As in the banking sector, over the past decade, users 2. OMNIPRESENT CARE of healthcare systems will be more autonomous, with Constant monitoring of data will leave the boundaries greater control over their data. Physiological data between blurred healthy habits, preventive medicine and medical records will not be under the control of and healthcare medicine. The distance between the hospitals or health care providers: people will have nature of these activities will be reduced and we will control over their own information and, consequently, see an export movement from the physical to the digital autonomy to make their own decisions. Each individual operational structure: the technology will allow exams, will have access to their own data and technological therapies and consultations to be carried out not only in capacity to process it, either on their smartphones or hospitals or laboratories, but in almost any environment, in their cloud storage accounts. whether by cell phone or personal computer.
In addition to the traditional forms of data collection The newest example is that of teleconsultation. The (exams, consultations), we will have constant capture ordinance issued by the federal government this year
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3. SCALE CUSTOMIZATION It is estimated that, in the last two years, 90% of the health data produced throughout history has been generated. With an ever-increasing storage and processing capacity and within reach, it will be possible for everyone to have highly customized and agile solutions for their well-being. One of the aspects that will guide this process is pharmacogenomics, capable of taking into account the individual’s genetic, behavioral and personal profile when producing a medication.
In parallel, we will see more and more digital implied rapid movements of hospitals and health services capable of making predictions according to operators to make the new service available. What our individual profile. Researchers at Northeastern previously could only be done in an office can now be University have developed a device capable of done from the living room of your own home. anticipating, within 1 minute, aggressive reactions resulting from autism. In another example, the Luminostics hardware – in the future, we will have the Guardian Connect app monitors the blood glucose same condition for carrying out tests (the Luminostics index and can anticipate, within 60 minutes, whether startup performs tests for infectious diseases from levels will become excessively high or low. simple hardware connected to the cell phone); monitoring vital signs (Binah.ai monitors five signals Within this universe, the possibilities will be endless. using the cell phone camera); therapies (studies at The increasingly accessible technology allows new universities around the world are enabling therapies solutions with high added value for people to appear through augmented reality); and several other at any time. Creating great experiences for the health procedures. Health and wellness assistance will be system users will be an obligation for service providers, truly 24/7: wherever we are, we will have preventive and it will be up to us, health professionals, to be always care, exams, consultations, therapies etc. attentive and investigating the new possibilities to build the future we want for health in Brazil.
Technology will open the doors, taking the centralization of information from medical institutions, bringing it to people and allowing them to have autonomy in decision making.
FÁBIO CALZAVARA Designer and entrepreneur. He has been working for more than ten years with projects for business innovation. Currently, he is Head of Innovation and Design at Hapvida Group. One of the co-founders of Namoa (an action platform that supports refugees) and Nura Café, in Pouso Alegre / MG.
| 27 AHERJ: COVID-19 IN THE STATE OF RJ
THE EVOLUTION OF COVID-19 in the state of Rio de Janeiro
Infection with the new coronavirus is believed to have hospitalization of critically ill patients, sometimes arrived in Rio de Janeiro during Carnival 2020. After intubated. The transfer of patients to neighboring the parties, there was a greater attendance in hospital cities, such as Niterói, São Gonçalo, Volta Redonda and emergencies for influenza syndromes. Hospitalizations Petrópolis, was constant. The virus internalized and took place mainly in classes A and B, especially for went to the small towns of the state. patients who came from the United States and Europe. It was the beginning of the pandemic in Rio. June was a difficult month. The wait for beds in the Intensive Care Unit (ICU) and Infirmary was high, and In April 2020, with the suspension of surgeries and private hospitals met a higher than expected demand. elective exams, the hospital beds were all destined Health professionals were on the brink of exhaustion. for the treatment of Covid-19. The rate of contagion In addition to the absenteeism of professionals due grew quickly, reaching levels of R.O = 3.0, that is, each to the disease, there was a lack of Personal Protective person transmitted the virus to three more individuals. Equipment (PPE), medication, anesthetics, and health inflation reached impractical levels, ranging from 40% In May, the occupancy rate of private hospitals was to 300% in some items. already 97%, and we were collapsing in the treatment of new cases. The majority of field hospitals were The financial decline of hospital institutions was not completed. Emergency Care Units were used for inevitable, and we went through the month of July with
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Facing this scenario, we arrived in December surrounded by diseases neglected during the pandemic that need to be treated, high rates of contagion, insufficient beds and accelerated numbers of the disease. We need unity to face the future and go through this passage with resignation, intelligence and planning.
The sunny November holidays brought dark and sad numbers of contagion, an explosion of emergency room visits, the occupation of beds for Covid and a further increase in the death numbers. Facing this scenario, we arrived in December surrounded by diseases neglected during the pandemic that need to be treated, high rates of contagion, insufficient beds and accelerated numbers of the disease.
We exceeded 180.000 deaths in Brazil. Vaccines are knocking on our door and we hope that by the end of 2021, all Brazilians will be immune and vaccinated. For this, we need to organize both in the acquisition and logistics of vaccination.
Christmas parties should be restricted to small groups, and that the summer should serve more as a teaching on preventive measures than large celebrations. We need unity to face the future and go through this many deaths, despite the decrease in hospitalizations passage with resignation, intelligence and planning. and the stabilization of care. In this flow, August We will spare lives and then, we can finally celebrate. was milder and we returned with elective surgeries, separating Covid beds from non-Covid beds (hospitals with Covid free areas). Treatment expertise reduced mortality, and there were less patient complications.
We started the economic reopening, but the Scream of Independence, on September 7th, brought an increase in contagion and in the number of cases and hospitalizations. The population was tired of isolation, and the explosion of parties and crowded bars led to a gradual growth in the number of hospitalizations. The GRACCO ALVIN population’s need to go out and interact with each other Director of the Association of Hospitals was great, and everyone’s anxiety for a return to the of the State of Rio de Janeiro (AHERJ) old normal increased the meetings and decreased the and executive director of Faturhelp distance, causing forgetfulness of preventive measures. Health Consulting.
| 29 OHLA 2020
DEBATE ON THE QUALIFICATION OF HOSPITAL MANAGERS IS HIGHLIGHTED AT OHLA 2020
Panel marked the launch of of working to strengthen the Brazilian hospital network, speaking of the satisfaction of launching, during the the English version of the event, the English version of the 2nd volume of the nd Hospital Manager’s Manual. “Throughout its trajectory, 2 volume of the Hospital FBH, an entity that represents more than 4.000 health Manager’s Manual, published establishments across the country, understood that providing hospital managers with practical information this year by the Brazilian and knowledge, which help these professionals in their daily lives, would be the best way to contribute Hospitals Federation (FBH) to the transformation that the sector so badly needs. The qualification of the network necessarily involves the preparation of its leaders”, highlighted Morato. The qualification journey of the hospital sector and He also emphasized FBH’s concern with the management the continued preparation of its leaders was the of small and medium-sized hospitals, which represent topic that marked the debates during the last day about 70% of the entire Brazilian network. “They are of the 2020 Omnia Health Live Americas (OHLA). managers who face difficulties and who need greater The panel, which was attended by the president of support for training, so that they can improve the the Brazilian Hospitals Federation (FBH), Adelvânio management of their establishments”, he added. Francisco Morato, registered the launch of the 2nd volume of the Hospital Manager’s Manual in English, a publication produced by FBH that aims to contribute MANUAL to the improvement of the production routines of Andréa Prestes, scientific organizer and author of two professionals who work in the forefront of health chapters of the Hospital Manager’s Manual, volume services management. The table also counted on the 2, explained that the publication seeks to combine participation of the scientific organizers of the work, theoretical knowledge, approached by thinkers, with Andréa Prestes and J. Antônio Cirino, in addition to the practical, everyday reality experienced by Brazilian Carlos Hiran Goes, CEO of AACI - Portugal and Brazil. managers. “Learning and continuing education are the best ways to promote change. This publication is an During the opening of the meeting, the president of effort to bring more knowledge and qualification to FBH, Adelvânio Morato, highlighted the entity’s mission hospital managers across Brazil”, she said.
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The choice of the conceptual line used in the “Throughout its trajectory, FBH, an entity composition of the work was discussed by J. Antônio that represents more than 4.000 health Cirino, scientific organizer and also author. He establishments across the country, highlighted the specific themes chosen for this second volume, “with chapters that complement understood that providing hospital each other and continue the issues that had already managers with practical information and been addressed in the first volume”. Cirino also drew knowledge, which help these professionals attention to the topicality of the themes of some in their daily lives, would be the best way texts, such as Change Management, Risk Management to contribute to the transformation that and Compliance, which, at this moment marked by a the sector so badly needs. The qualification pandemic scenario, of strong inconstancy, deserve special attention in the preparation of leaders who are of the network necessarily involves the at the forefront of strategic health services. preparation of its leaders”
The institutional role of FBH, of making available to Adelvânio Francisco Morato, the segment an important instrument for training president of FBH professionals who are in the administration of health services, was also stressed by the CEO of AACI - Portugal OHLA 2020 and Brazil, Carlos Hiran Goes. “There is no change if Omnia Health Lives Americas (OHLA) is the largest there is no will in human achievement. Managers who virtual exhibition of healthcare solutions and services are in a strategic position must bring, in their concept in Brazil and the Americas. The 2020 edition was of leadership, the human will as a precursor to this held between November 2nd and 6th, and had an improvement process”, said Goes. extensive program, with more than 30 virtual sessions and the participation of about 700 companies. OHLA is promoted by Hospitalar, in partnership with the events Fime and Expo Med, from the United States and Mexico, respectively.
| 31 SPECIALTY
CHRONIC OBSTRUCTIVE PULMONARY Disease records four deaths per hour in Brazil
In Brazil, Chronic Obstructive “COPD World Day is a date on which we need to clarify for people what the disease is, expand knowledge and Pulmonary Disease (COPD) alert them to early diagnosis. With that, patients can undergo treatment and greatly improve their quality affects 6 million people. of life”, reinforces the specialist. Difficulties in diagnosis and CAMPAIGN AND NEW adherence to treatments are TREATMENT among the main aggravating With its social commitment to respiratory health, GSK, in June, in partnership with SBPT, the ProAr Foundation, factors. the Chronicles of the Day Association, UOL, the Drauzio Varella Portal, Minha Vida, Avós da Razão On November 20th, World Day of Chronic Obstructive and Avosity, launched a campaign entitled “COPD - Pulmonary Disease (COPD) was remembered, a Information Inspires”, to bring consistent information pathology characterized by the obstruction of to the population about the real impact of the disease, airflow in the lungs, caused by cigarette smoke or popularly known as pulmonary emphysema, and other harmful compounds to respiratory health. The which, in the next decade, could be the third leading estimate, in Brazil, is that about 40.000 people die cause of death worldwide. Aimed at the general annually from COPD, which already represents four public, the campaign has a series of content on the deaths per hour, and it is becoming an increasing portal (https://www.dpocinformacaoinspira.com.br) concern among specialists. dedicated to the most relevant issues of this pathology, still very underdiagnosed. According to the Brazilian Society of Pulmonology and Tisiology (SBPT), Brazil currently has 6 million people Another novelty for COPD patients is the arrival of an living with COPD. This pathology is known to increase innovative treatment option, which can greatly impact the risk of Covid-19 severity. In addition, “there was the quality of life of those with COPD: Trelegy, the main a decrease in consultations for these patients in launch of GSK in the respiratory area, in the last 20 this pandemic period”, as commented by Franco years. This new therapy brings as its main differential Martins, pulmonologist and medical manager at GSK, an innovative combination of three molecules - which further reinforces the importance of care and fluticasone furoate, umeclidinium and vilanterol treatment adherence. - together in a single inhaler, used only once a day.
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“The patient uses it once a day. It improves treatment adherence, making the routine of these people more comfortable. In addition, research has shown a reduction in the rates of crises and hospitalizations in a specific scenario”, says Franco Martins.
COPD COPD, as stated, is characterized by obstruction of airflow in the lungs and is usually caused by cigarette smoke or other harmful compounds. The disease has no cure, but it is preventable and treatable. The condition is commonly confused with the signs of the aging process and smoking, which makes diagnosis and treatment more difficult. According to the World Health Organization (WHO), currently 64 million people live with the disease in the world, while 3 million have already died from the disease. In Brazil, 61% of affected people reported frequent visits to the emergency room due to exacerbation, a factor that increases the risk of mortality. In addition, 25% needed hospitalization for the same reason.
| 33 34 | HOSPITAL MANAGEMENT VISÃO HOSPITALAR MAGAZINE AND NOW, WHAT IS THE STRATEGY?
“If the canoe doesn’t turn, I’ll get there”. Making an scholars consider the hospital as one of the most analogy to this famous Brazilian Carnival marchinha, complex organizations to manage. this is how many health organizations positioned themselves in the market before the pandemic, Along with all this complexity, how is it possible to many of these with satisfactory results, because, promote efficient management, supported by the although the canoe rocked, it had not yet turned. best practices and methodologies, in order to face When comparing the status quo of the canoe on the the current known challenges and the unknown ones sometimes turbulent waters, which allows itself to that are yet to come? At first, the attempt to organize be carried away by the current without even knowing or create methods to manage in an increasingly the navigated route, with health institutions, which, volatile, uncertain, complex and ambiguous scenario, by not having a clear and stated strategy, only react the so-called VUCA world, seems paradoxical. The to the pressure of the external scenario, we realize market has long been showing the inevitability of that both are in danger of sinking. If even before the constant reinvention; however, it was only with the pandemic this stance was already an imminent danger pandemic that a large number of health organizations to the survival of hospitals, what can we say from now understood this need. And now, what will be able to on that the canoe has turned? The pandemic brought contribute to a healthy survival for hospitals? What is up problems that already existed, most of them the strategy? camouflaged and contained amidst the routine and daily pressure that falls on hospital managers. At this point, we can say that the strategy is to “have a strategy”. Talking about strategy is not the talk of a Hospitals have been fighting for survival in the market theorist, an administrator or a consultant. This issue for a long time, facing various overcoming needs, should be on the agenda of all hospital managers who such as new technologies, both in equipment and are in charge of the institutions. In addition to having medicines, associated with the obligation to remain a strategy, it needs to be clear and known to all who in conformity with the various existing regulations, make up the organization. It is crucial that employees not to mention the enormous tax burden on these know why they do their daily work; the reason for their organizations. Still, in the quest to ensure safety goals; what is the meaning of continuous improvement and quality in the care provided to patients, they projects and cost rationalization; and so many other strive to be in line with existing guidelines. This is all subjects demanded in the day to day organizational. challenging. It is no wonder that great management People tend to adhere to and participate in what they
| 35 HOSPITAL MANAGEMENT
know and believe. If they don’t know what the hospital you manage? Is there a common plan for leaders to expects from their actions, the message they can get is develop actions with their teams in order to comply that any result will do, and so the tendency is for them with the organizational strategy? to act according to their individual interests and not because of a collective institutional purpose. It is up to each hospital manager the challenge of turning the canoe over, supporting, sustaining, The hospital manager must be attentive to the preparing and directing the teams so they can remain definition or reassessment of the strategy, in the search firm, strong, safe and confident when paddling, to include tools, processes and directions capable of even against the tide, but in the same direction. The generating more security and clarity for the work of hospital manager’s main role is to show the way, to the employees and providing a prospecting based on be the support along the way, to promote everyone’s facing adverse moments. It is essential that there is a engagement so that the positive result is increasingly cultural assessment to show the current possibility of possible, evidenced, recognized and celebrated. implementing the expected changes and to raise the essential factors to be worked on internally, in order to guarantee the success of the planned. Knowing that organizational culture is able to override strategy What will be able to in a “direct conflict”, it is essential to have strong and active leaders capable of sustaining the necessary contribute to a healthy transformation process. It is the leaders’ task, by means survival for hospitals? of a congruent conduct, to promote the alignment and engagement of employees to what is intended.
And you, hospital manager, do you know what your organization’s strategy is? Is it clear? Do your peers ANDRÉA PRESTES CEO of Andréa Prestes Institute (API) and and followers have the same understanding? How General Manager Portugal of the American many hours of your day, week or month do you invest Accreditation Commission International (AACI). in actions geared to the strategy of the hospital
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SHARED SERVICES CENTER PROMOTES management gains for hospitals in Minas Gerais
Focusing on control of expenditures in the Health Certification of the National Accreditation Organization Sector, the Board of the Central Hospital of Minas (ONA), in addition to the implementation of the Gerais created, in a pioneering way, the Shared Therapeutic Plan, training and capacity built on ONA Services Center (CSC), so that the health institutions requirements etc. A properly implemented quality of Minas Gerais can benefit from this concept in management system means that the organization provision services. does not focus only on the effectiveness of processes (extent to which the planned results are achieved), but More than two years ago, the Shared Services Center also their efficiency (relationship between the results established itself as an administrative pole that allows achieved and the resources used). companies to obtain major cost reductions and, at the same time, gain in quality and speed in the execution of administrative processes. It is an alternative for the PARTNERSHIP Implement this new concept in the provision of execution of activities that are not part of the core services and guarantee the improvement in quality business of a hospital or a health clinic. and cost reduction for your health institution, in any part of Minas Gerais. Contact us for more information! RESULTS The numbers and results of the CSC RH, of the Central We already have projects underway for the of Hospitals of Minas Gerais, already have more implementation of new CSC services, such as: Clinical than 5.000 professionals recruited; more than 1.500 Engineering, IT, Legal, Billing, Communication, among others. contracted professionals (an average hiring time of 13 working days); more than 70 technical visits; More than two years ago, the Shared and curriculum database with more than 30.000 Services Center established itself as professionals registered directly through the Central Hospitals website (www.centraldoshospitais.com.br). an administrative pole that allows In addition, CSC RH has a software that assists in the companies to obtain major cost management and monitoring of the entire R&S process. reductions and, at the same time, gains
The CSC Quality helped several hospitals and clinics in quality and speed in the execution of to achieve the Unimed Seal of Excellence and the administrative processes.
| 37 MANAGEMENT AND HEALTH
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| 39 SYNAPSIS AWARD
VIRTUAL CEREMONY marks the delivery of the 2020 Synapsis FBH Journalism Award
By Felipe Nabuco [email protected] Covid’s standard victim in Brazil”, the reporter of Revista Época, Marcelo Soares, highlighted the In its sixth edition, the award difficulties of journalists to obtain accurate data about the pandemic. Marcelo’s investigative work is already consolidated also resulted in the creation of a detailed journalistic among the main events in the database about Covid-19 in Brazil. country’s journalistic calendar With a report on “Abnormal delivery - obstacles to humanized birth”, journalist Gabriela Mayer, from BandNews FM, took the award in the Radio category. In the Internet category, the winner was journalist Juliana The Brazilian Hospitals Federation (FBH) presented, Contaifer, from Portal Metrópoles, with the article “Zika in a ceremony held for the first time in digital format, mothers abandoned in the heart of the country”, which concerning the preventive measures against the portrays the scenario of uncertainties and afflictions of coronavirus, the winners of the 2020 Synapsis FBH mothers who received the diagnosis of microcephaly Journalism Award. In its sixth edition, the award, from their children due to the Zika virus. created to promote journalistic production in the health area, received a record number of entries, “The Synapsis Award honors the important work that with 233 classified reports, and recognized, with the Brazilian press does for the Health Sector. This the delivery of a trophy and payment of R$ 15.000, year, we broke the record for registrations, and this the four best in the Radio, Printed, TV and Internet makes us very excited, as we know the importance categories. of information for the improvement of the sector. We want to continue advancing with this important In the TV category, journalist Luciane Marques de award and, with this, encouraging even more the Oliveira, of Rede Amazônica, took the prize with participation of journalists in the daily construction the article “Manaus lives in chaos in hospitals and of our health system”, said the president of FBH, cemeteries because of the coronavirus”. The report Adelvânio Francisco Morato. was shown on Rede Globo’s TV program Fantástico, and showed the severe impacts of the pandemic peak in the capital of Amazonas. AWARDS The Synapsis Award has been promoted since 2015 by The winning article in the Printed category also the Brazilian Hospitals Federation (FBH). As sponsors, addressed the pandemic theme. In “SUS data reveal it has the Hapvida group, the largest health insurance
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operator in the North and Northeast of Brazil, and This year’s ceremony was conducted by journalist Hospitalar, the largest and most relevant business and broadcaster Fátima Uchôa. To select the winners, fair in the Health Sector. The award also receives the award had a jury team composed of qualified institutional support from the National Federation professionals with practical experience in the of Journalists (Fenaj) and the Brazilian Radio and journalistic area. Among them are: Luiz Carlos Duarte, Television Association (Abratel). journalist and writer; Michelle Trombelli, journalist and special reporter for Producer Doc Films - she has also With each edition, the Synapsis Award, which arose to done journalistic work at Band, Bandnews FM and CBN; provoke reflections in favor of improving the Brazilian and Clauber Bezerra, journalist, Political Marketing health system, has been consolidating itself as an and Communication consultant. They evaluated opportunity for journalists to be recognized for their all classified works, according to technical criteria work developed in search of proactive debates and established by the organizers of the sixth edition of solutions for the improvement of the sector as a whole. the Synapsis Award.
PRESIDENT OF FBH
The Synapsis Award honors the important work that the Brazilian press does for the Health Sector. This year, we broke the record for registrations, and this makes us very excited, as we know the importance of information for the improvement of the sector” – Adelvânio Francisco Morato, president of FBH
JURYMAN
| 41 SYNAPSIS AWARD
HOST OF THE SIXTH EDITION
WINNERS
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SPONSORS
| 43 44 | VISÃO HOSPITALAR MAGAZINE
DOWNLOAD YOUR HOSPITAL MANAGER MANUAL VOLUME 1 AND 2 NOW
Or access: www.fbh.com.br/publicacoes-fbh/ INTENSIVE THERAPY
TELEICU AND THE EVOLUTION of care in Intensive Care Units
The pandemic that occurred this year, due to Covid-19, only exposed a problem that, in Brazil, was chronic and was not given due attention: the small number of intensive care beds and the poor distribution of those in the different regions. In a country with continental dimensions, it is natural to have many logistical difficulties, but these difficulties served to show that tools exist and that they should be used.
In this context, TELEMEDMS is launching TeleICU, an innovative service that brings together patients with high severity of health professionals specialized in Intensive Care Medicine. A hospital unit, equipped with the necessary structure and equipment for an Intensive Care
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Unit (ICU), needs intensive care doctors to be able Due to the severity of some diseases, the patient to function. This is a specialty that has few qualified admitted to an ICU has a greater chance of survival, professionals and, generally, that are concentrated in since care is intense. Depending on the distance large urban centers. from the location to a large center, the transportation of this patient can mean the difference between life With TeleICU, the distance barrier is easily overcome, and death. making it possible to place the intensive care physician within the units, in places where this would previously The greatest benefit of TeleICU is the speed with which have been impractical. Upon admission, the patient is cases are handled, in addition to not putting pressure treated by the unit’s clinical physician, who performs on the health system in large centers, which also work the first procedures. After that, he analyzes the patient’s with their capacities to the limit. condition, through the available tests, and calls the specialist doctor, through a video call. “This year has had a major impact on health systems. Due to the pandemic, I accepted a new challenge to coordinate a remote ICU. The need to attend to seriously ill patients, with respiratory failure, exposed the lack of intensive care units, mainly in the interior of Despite being available the country. Online coordination was a way of bringing intensivists closer to colleagues at the top. When you for any hospital, TeleICU have an efficient information system, this type of work is rewarding, as we see colleagues growing up with us. finds its main audience in And the best: we have achieved results comparable to large centers”, explains the intensive care physician hospitals far from large César Romero de Oliveira Sales. centers, which have As for the on-duty doctor Erison Bambil Leite, one of the professionals assisted by TeleICU, the difference a minimum intensive is in the confidence that the method provides. “Telemedicine gives confidence to us, clinical doctors, care structure, mainly in the care of critical patients, making it possible to provide good medical assistance for the patient’s good, monitoring and life with the support of the specialist.” The emergence of the Covid-19 pandemic caused support equipment. hospital units to reinvent themselves, creating intensive care centers where this was not previously practicable. This is a trend that should continue, as the need has shown that there are technological resources that can Within a proprietary platform, all patient information be used, and that many lives are saved with it. is recorded, so that the intensivist has access to this data and can assist the doctor on duty in the best For the populations served, a hope arises: to know that, course of action. if necessary, help is very close. A life saved by TeleICU is already worth every effort in the project. TELEMEDMS Despite being available for any hospital, TeleICU finds is proud of the pioneering nature of this project in Mato its main audience in hospitals far from large centers, Grosso do Sul. which have a minimum intensive care structure, mainly monitoring and life support equipment.
| 47 AHECE
THE INTEGRATION OF PRIVATE HOSPITALS against Covid-19 in the Ceará state
In this scenario of necessary adjustments, I believe that the great challenge imposed on the management of health establishments from now on will be to permanently qualify its human resources. Professionals capable of doing their jobs efficiently and wisely help management to deliver better operating results and, consequently, better care for patients and family members.
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The year 2020 demanded profound changes from us, The suspension of elective surgeries caused financial which made us reinvent ourselves at an impressive losses for thousands of establishments, especially speed. The greatest health crisis of the last century small and medium sized ones. With a large part of the leaves lessons that have been assimilated quickly and structure idle, unable to receive patients, these hospitals demanding adjustments from us in a way that we need had serious difficulties in maintaining their employees’ to plan for the future. One thing is certain: the world will payrolls. Many came close to closing the doors. never be the same. It was seven months of an intense struggle that united In this scenario of necessary adjustments, I believe that the the entire health segment in the Ceará state. And private great challenge imposed on the management of health hospitals, once again, have proven their historical establishments from now on will be to permanently importance for the Brazilian health system. AHECE was qualify its human resources. Professionals capable of integrated into the planning of the Municipal and State doing their jobs efficiently and wisely help management Health Departments, and private hospitals started to to deliver better operating results and, consequently, act coordinated with the permanent surveillance work. better care for patients and family members. Today, it is worth mentioning, the Supplementary Health sector accounts for 40% of hospital care performed only Having a highly qualified and continuously trained team in the metropolitan area of Fortaleza. is as necessary for the evolution of results as undertaking in technology, modernization and innovation. This Thanks to this integrated work and the lessons, we had finding is even more evident in the Health Sector to absorb quickly, the state of Ceará has managed to and gains greater proportions within the hospital maintain a good result in tackling the pandemic. Today, environment, where the greatest diversity of specialists service is reduced in apartments and ICUs, compared and the greatest technological density to save lives are to the initial moments of the crisis. This is due, in large concentrated. part, to advances in studies and treatment with the disease, such as the constant review of protocols. In The performance of the Association of Hospitals and the outpatient area, however, the circulation of patients Health Establishments of the Ceará State (AHECE) has is still large, but this was also a stage of care that has focused on executing an extensive program aimed at considerably evolved and it has been able to solve most professional qualification in different areas of the sector, of the demands without patients needing to be moved with several courses, symposia and congresses offered to intensive beds. to the category. In the past year, however, the Covid-19 pandemic has caused the entire calendar we had In all these years working directly with hospital planned to be re-discussed. We reinvent ourselves and management, a teaching that has always remained face the situation bravely together. current in my reflections is that investment in knowledge, planning and qualification is the best way to obtain It is important to take note that there were many safe results. This Covid-19 pandemic only confirmed a problems. The first was the scarcity of Personal certainty, which we often neglect in our complex job: we Protective Equipment (PPE) and supplies, such as masks need to prioritize our human resources! and 70% alcohol. Then came the suspension of elective procedures and the rush for beds of surgical recovery to be transformed into Intensive Care Unit (ICU) beds - the greatest need revealed by the Brazilian health system in this pandemic. The problem is that there is no point in opening more beds if we do not have trained LUIZ ARAMICY BEZERRA PINTO professionals available in the market to take on these President of the Association of Hospitals and vacancies. Across Brazil, and in Ceará in particular, it Health Establishments of the Ceará State was no different: specialists in Emergency and ICU were (AHECE) and secretary-general of the Brazilian Hospitais Federation (FBH), an entity that he also lacking to meet the growing demand. chaired between 2012 and 2018.
| 49 DIGITAL HEALTH
HOW DOES INCREASED INTELLIGENCE AND TELEMEDICINE assist in the medicine humanization?
It is unnecessary to emphasize the role that technology Telemedicine, artificial intelligence has played in the Health Sector in recent years. The facilities, advantages and benefits have already and increased intelligence help to been thoroughly proven. Its applications are diverse humanize and make the doctor- and distinct, ranging from clinical care to diagnostic patient relationship even closer. support and even management. However, even so, some paradigms are yet to be broken. One is the fallacy that telemedicine, artificial intelligence and increased intelligence make the doctor-patient relationship robotic Artificial intelligence is self-resolving. For example, an and distant. algorithm created to interpret an electrocardiogram is capable of generating an automated and increasingly It is not so. In fact, it is exactly the opposite: these assertive and functional report. Increased intelligence, technologies help to humanize and make the doctor- on the other hand, is when, based on this created patient relationship even closer. We all know that algorithm, the professional has support to make a clinical medicine has changed a lot over the years. New decision or request another exam. Finally, it leads the treatments, new clinical protocols, etc. appear every day. professional to cognitive thinking in order to maximize Not to mention that, every day, it is necessary to deal with human assertiveness. new diseases, as was the case with Covid-19, which still brought with it a need for social isolation. The speed with Thus, I believe that artificial intelligence is used in a few which everything happens makes it very difficult for the areas of medicine today (for now), but in many or all doctor to keep up to date, monitor and, above all, absorb of them, increased intelligence can be used. There are all these changes and information. already some technologies that provide insights into the paths to be followed in the diagnostic completion Well, this is where increased intelligence and process; others are able to analyze laboratory test results technologies for clinical decision support come in. But, with great assertiveness. Of course, the opinion and wasn’t it artificial intelligence? Why are we now talking experience of the physician will always prevail, but these about increased intelligence? Let me explain. Although technologies speed up obtaining information and bring we are used to hearing the term artificial intelligence, we more precision to the entire care process. are talking about two different things.
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The expected result? The doctor has more time during how this technology would be able to increase their the consultation to listen, understand, analyze and, productivity and capillarity in relation to their care and especially, get closer to his patient, converting that into a procedures. more human relationship between doctor and patient, in tune to what is preached nowadays: patient at the center The truth is that telemedicine expands the doctor’s of care and value-based medicine. service capacity and allows him to assist a larger number of patients, remotely and even from different geographic Another classic example of technology that has locations, in a single day of work. In addition, patients also broken some paradigms with the pandemic is who sometimes live in more distant regions may have telemedicine, which, especially in Brazil, was not viewed access to specialists they did not have before. favorably. I tend to make a very relaxed analogy: it was like Voldemort, in the Harry Potter films series, the one And if we combine the two (telemedicine and increased who cannot be named. intelligence), we will certainly arrive at a service that is not only more human, closer, but also more complete Although there was already a strong movement in other and with a high level of excellence. In other words, countries and we have been working with innovative everyone wins. telemedicine technologies here for more than 15 years, we have not seen any progress. The supposedly negative side was: technology would replace the health professional figure. What we now know is something MARCELO FANGANIELLO totally false. Director of GetConnect, Telemedicine, Integration and Connectivity division of In addition to the lack of demand from the patient, it OxySystem. was not very clear, for the Brazilian health professional,
| 51 HOSPITAL INFECTIONS
WE HAVE BEEN LIVING A SILENT PANDEMIC FOR A LONG TIME
2020 was a unique year, with our eyes focused almost the invariable death of patients. According to the exclusively on the Covid-19 pandemic. But the great truth National Biosafety Association (ANBio), 100.000 patients is that for years we have lived with a silent pandemic that die every year due to HRIs. has spread to health services all over the world. These are called healthcare-related infections (HRIs) or, in The National Health Surveillance Agency (Anvisa), in its simple terms, hospital infections. recent alerts (GVIMS/GGTES No. 01/2020 and 02/2020), confirmed the presence of the “superfungus” Candida Data from the World Health Organization (WHO) indicate auris in a patient admitted to a private hospital in that Brazil has a prevalent rate of healthcare-related Salvador, Bahia. The theme is not new, only that, here, infections of 14%, that is, for every 100 surgeries there has never been a positive identification of this performed, 14 have hospital infections. According to micro-organism. DATASUS, 3.2 million surgeries were performed in the country from January to October 2020. In a fast crossing The microorganisms involved in HRIs in Intensive Care of data (WHO x DATASUS) we found that more than Units (ICUs) and more frequent in Brazil, according 460.000 surgeries (that is, people) were affected by to Anvisa, are already resistant and multi-resistant. these infections. Among them are superbugs like KPC (2nd place), and, surprisingly, water bacteria, like Serratia (10th place), are Comparatively, we live in the Covid-19 pandemic and also present. And what is contaminating patients with are shocked when the person-to-person infection rate Serratia? exceeds 1. However, the rate of hospital infections in Brazil exceeds this mark, surprisingly reaching 1.4 - that If hospital institutions have so many resources is, 40% higher. And why are we not publicly concerned, (intellectual, technological, structural, financial, among as we have been with the Covid-19 pandemic? The others), the question remains: why are there so many apparently simple answer is that cases of hospital challenges to avoid HRIs at all costs? We are losing infections can be treated or attempted to be treated with the fight and, increasingly, lives are affected by these existing drugs. infections every year.
We treat those with isolated drugs or combine them in Although there is evidence that quaternary ammonium is the desperate action to eliminate hospital infections. not recommended for disinfecting surfaces contaminated However, in this action to save lives, microorganisms by Candida auris (they have caused infertility in rats learn and become resistant or multi-resistant, causing and there are studies of resistance microorganisms and
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reports of occupational asthma), these continue to be IVAM CAVALCANTE PEREIRA JR. widely used in Brazil, as they are considered to be cheap. Graduated in Business Administration. He holds The cost-benefit of challenging care and life certainly several courses, such as Marketing, Startups and Customer Data, Business Model Innovation, needs to be assessed. Is it worth it? Strategic Administration, Business Leadership, Logistics Planning. He is considered Blue Belt in Despite all these challenges, the culture of manual Six Sigma. He is currently the executive director of cleaning processes (concurrent and terminal) remains the DeVant Care. standard, and studies show that it is often inadequate, taking risks and HRIs to patients. If we have automated, validated and effective options, why continue to do the same thing, believing that the best result will be obtained?
Hydrogen peroxide solutions with silver (hospital) and without silver (food), using proprietary dry vaporization technologies validated by standards and in vivo studies, have proven to be extremely superior to other disinfectant solutions and technologies in combating microorganisms, in reducing the risk of HRIs and in disinfecting environments and surfaces in these places.
Evolving is a choice, often available, that costs time and resources, but also saves lives. Lives are priceless: this is a worldwide consensus and is the basis of caring. It is up to us to do the right thing, without the need for laws, simply because we have common sense.
| 53 GENERAL DATA PROTECTION REGULATION
ASSOCIATION OF HOSPITALS OF THE STATE OF GOIÁS signs partnership to help members to adapt to the new Law
The legal counsel of the Association of Hospitals of the has been demanding an immeasurable flow of sensitive State of Goiás (AHEG) signed, with the support of the information, especially related to health and patients Brazilian Hospitals Federation (FBH), a partnership with around the world”, says Morato. the P&B Compliance consultancy, with the objective of assisting health establishments associated with the SENSITIVE DATA AND implementation of the General Data Protection Regulation (GDPR). The services offered by the consultancy cover TRANSPARENCY three essential pillars: Legal, Information Technology and One of the points that deserves full attention in relation Information Security. to the GDPR concerns the consent of the user/patient in the clearest possible way. Keeping an eye on this, AHEG “Investments in the digital world are no longer has also sought to guide its associates on how to make complementary and have become of huge importance an appropriate Consent Form to the new Regulation. in everyday social relations. At the heart of each of these Consent for the processing of health data (classified as changes is the ability to collect, analyze and store data sensitive data by the GDPR) is the main legal hypothesis and information securely in the quest for the evolution that allows the treatment of this type of data, other legal of care “, analyzes AHEG’s legal advisor and lawyer, bases being exceptions to consent permitted in specific Leonardo Rocha Machado. The president of AHEG, situations provided for by law. who also chairs the FBH, Adelvânio Francisco Morato, endorses the advisor’s analysis. “That is why both AHEG “In this sense, one of the main doubts of companies and FBH have spared no effort in the search for all the and health professionals is how this consent should mechanisms to assist our associates”, he emphasizes. be obtained from patients (who are the data holders), mainly because it can be obtained in most cases in Morato also recalls that, at this moment, it is necessary which health data is processed”, observes Machado. The to seek as much information as possible and adopt a concern with the form is important, since the Regulation proactive and preventive position, making use of best seeks to protect and guarantee the holder, so that he has practices and strategic planning. “One thing is certain: it a minimum of control over whether, how and when his has never been more important to implement protection data will be used, even more because it is critical data of personal data considering this whole context, which that can be used both positively and abusively.
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CONSENT FORM explanations, without the possibility of disagreeing The new Regulation defines how consent for sensitive with the treatment or the absence of clarification of and health data should be obtained through a series of doubts can violate the free expression of will”, observes requirements that must be put in place by the controller. Machado. “The GDPR seeks clarity in handling information, so the more specific the Consent Form is, the better”, explains PARTNERSHIP Machado. The lawyer draws attention to the purposes of Members who are interested in the services data collection, which must be clearer, more specific and offered by the partnership with B&W Compliance determined. can contact AHEG’s legal counsel by phone: +55 (62) 3093-4307. The values may vary between “The training of employees is fundamental to avoid R$ 20.000 and R$ 70.000, which will be paid in any type of coercion or imposition, because the installments to members up to 12 times. simple requirement of signing without the necessary
“One thing is certain: it has never been more important to implement protection of personal data considering this whole context, which has been demanding an immeasurable flow of sensitive information, especially related to health and patients around the world”
Adelvânio Francisco Morato, president of AHEG and FBH
Adelvânio Francisco Morato, president Leonardo Rocha Machado, lawyer and legal of AHEG and FBH. advisor to AHEG.
| 55 PSYCHOSOCIAL ATTENTION
FEDERAL GOVERNMENT ACTIONS TO STRENGTHEN PSYCHIATRIC HOSPITALS – New National Policy on Mental Health and Drugs
For more than three decades, patients with severe Psychiatric hospitals are essential mental disorders and chemical dependency, as well as their families, have experienced a situation of severe for the comprehensive, effective lack of assistance due to mistaken and ideological public policies that were instituted by former Federal and humanized treatment of Government administrations. Among the various people with mental disorders and mistakes made, one of the main ones was the closure of psychiatric beds and hospitals. Because of this, Brazil has chemical dependency a deficit coverage in this assistance modality.
Adding beds in psychiatric hospitals and those in general hospitals, there is, in the country, a rate lower than 0.1 bed per 1.000 inhabitants. This index is below the average coverage of the countries of the Organization for Economic Cooperation and Development (OECD), negative impacts on the health and well-being of the population are perceived when this rate is below 0.3 per 1.000 inhabitants.
Due to the serious mistakes made in the conduct of public mental health and drug policies in the country, the outcome indicators in these areas were alarming: sustained growth in suicide rates in the last 15 years; increase in individuals with severe mental disorders living in the streets; incarceration of patients with severe mental disorders; increased mortality of such patients; overcrowding of emergency services, with patients
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waiting for admission; increased drug use and chemical Proof of this is that, since 2017, the Ministry of Health dependency in the country; growth and expansion of has been working to provide financial resources to “cracolândias” (land of crack) in most Brazilian cities; psychiatric hospitals. As a result, there was a significant increase in patients on social security leave, mainly due increase in the number of parliamentary amendments to to depression and crack addiction. these hospitals.
Seeking to change this bleak scenario, in the past three Thus, in December 2017, the New National Mental years, the Federal Government has been carrying out a Health Policy was published (Resolution of the Tripartite series of actions, especially regarding to strengthening Commission of the Unified Health System No. 32/2017 psychiatric hospitals, recognizing them as entities of great and Ordinance of the Ministry of Health No. 3.588/2017), importance for the provision of comprehensive, effective which included psychiatric hospitals as an integral part and humanized treatment for people with mental of the Psychosocial Care Network (Raps). In addition, day disorders and chemical dependence, contributing, even, hospitals and outpatient clinics were also included in for the financial resources to these services, through the Psychosocial Care Network, with many of these two different actions in several fronts. services operating in psychiatric hospitals. As a result, the idea of a substitute care network was abandoned in favor of a complementary services care network.
After almost ten years, the daily rate of psychiatric hospitals was readjusted by 65% (Ordinance of the Ministry of Health No. 3.588/2017). In the sequence, the daily rates of long-term hospitalizations were also corrected (more than 90 days) (Ministry of Health Ordinance No. 2.434/2018). As a result, there was an increase in funding of R$ 230 million/year to psychiatric hospitals across the country.
In addition, Ministry of Health Ordinance No. 544/2018 was published, which started to finance therapeutic teams for mental health clinics. These teams can even be installed in outpatient psychiatric hospitals, which increases the possibility of providing financial resources for assistance in these hospitals.
Technical Note No. 103/2018 was also published, which opens the possibility for psychiatric hospitals to participate in the Ministry of Health’s 100% SUS Program, which provides additional financial resources for these services. Before that, psychiatric hospitals were prohibited from participating in this Program, unlike what happened with all other hospitals. This discriminatory attitude was clearly aimed at financially asphyxiating these services.
In April 2019, the Federal Government launched the New National Drug Policy, through Presidential Decree nº 9.761/2019, which placed psychiatric hospitals as part of the care network for patients with chemical dependence, becoming part of the National Public Policy
| 57 PSYCHOSOCIAL ATTENTION
System on Drugs (Sisnad). Thus, psychiatric hospitals are part of both Psychosocial Care Network and Sisnad, which ensures important legal security for their operation.
Shortly thereafter, in June 2019, the New Drug Regulation (Federal Regulation No. 13.840/2019) was signed by the President of the Republic, which even included the possibility of involuntary hospitalization for drug addicts (ratifying the provisions of Federal Regulation No. 10.216/2001) in health facilities, such as psychiatric hospitals.
In this current moment of the coronavirus pandemic, the Ministry of Health published Ordinance No. 1.393/2020, which provided emergency financial aid to philanthropic psychiatric hospitals, seeking to help them through this difficult sanitary moment. The Ministry of Citizenship, through the National Secretariat for Drug Care and Prevention (Senapred), launched a guideline booklet to help entities access the resource, and also began to accredit psychiatric hospitals as Reference Centers in Chemical Dependence (Ceredeq), with the objective of helping these services to improve their quality of care (Ordinance No. 437/2020).
Obviously, there is still a long way in order to strengthen psychiatric hospitals in Brazil, however, without a doubt, the Federal Government has been working hard in this direction, acting firmly with public managers and the Justice against the closure of these hospitals throughout Brazil, having managed to prevent the closure of several of them in different states.
QUIRINO CORDEIRO Psychiatrist, former Mental Health coordinator at the Ministry of Health. He is currently the National Secretary for Drug Care and Prevention at the Ministry of Citizenship.
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| 59 PALLIATIVE CARE
HOSPITAL RESCUES ESSENCE OF MEDICINE WITH PALLIATIVE CARE INVESTMENT
Professionals at the Cajuru University Hospital value listening and getting closer to patients and family members to bring relief to suffering
Rescuing the humanistic essence of Medicine, focusing on the patient, and not on the disease, is the principle of the palliative care team at the Cajuru University Hospital, located in Curitiba (PR). The institution has a commission that is dedicated to caring for end-stage patients and their families, taking care of the physical, emotional, social and spiritual symptoms of the disease. In the midst of the Covid-19 pandemic, in which many patients cannot receive their family members’ visits, the team’s work takes on an important meaning in this comfort process.
According to Ronnie Ykeda, coordinator of the Commission for Palliative Care at Cajuru University Hospital, palliative care can be defined as “an approach to give dignity and relief from suffering to patients with serious life-threatening illnesses”. “Many patients connected to devices in Intensive Care Units (ICUs) are dying away from their families. From the palliative care approach, we recognize patients who will not benefit from high medical technology and seek to bring maximum comfort to these people. For example, having
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the family at all times by their side, preventing them from being unnecessarily connected to tubes and even being able to have their pet at the hospital”, says Ykeda.
CHANGES WITH THE PANDEMIC Currently, due to the pandemic, visits are restricted in most cases. Even so, the palliative care team finds ways to adapt to the new reality, as Ykeda explains: “We work with the medical principle of family autonomy: we explain the pandemic issue to everyone and they decide whether or not to keep visiting. In general, patients are Ronnie Ykeda, coordinator of the Palliative Care able to have their family close by 24 hours a day, with at Commission of the University Hospital Cajuru. least one relative near them at all times”.
Credits: Disclosure/HUC. The safety procedures for approaching occur differently for patients in the ICU and in the Infirmary. “For the ICU, we are focusing on video calls between hospitalized people and relatives. In the Infirmary, visits always take place with the necessary Personal Protective Equipment (PPE), as well as guidance to visitors on risks and care. We realized that people have become aware”, comments the coordinator.
In its three years of operation, the Palliative Care Commission has served more than 300 patients, in addition to their families. Between March and October 2020, 81 patients were treated, with new recommendations for care for the whole family due to the pandemic.
VALUE OF FAMILY CONTACT According to the team coordinator, the fact that relatives and patients have the chance to get closer at this moment, during the palliative care process, means the appreciation of family ties and the chance for comfort.
The doctor explains that the pandemic that the world is going through, in a way, can bring a high burden of anxiety to the general population. “We consider it important to have the opportunity and the benefit of seeing the sick person and being able to say goodbye to the patients who are in the hospital. We try to reduce people’s anxiety at this point. It is very cruel not to be able to say goodbye to a relative,” he says.
| 61 PALLIATIVE CARE
THE IMPORTANCE OF THE and to understand that death is the last and most sublime event of life. In general, the health professional HEALTHCARE PROFESSIONAL is frustrated with the loss of a patient, and when that “The hospital has a multidisciplinary team (psychologists, happens, it is because he is focused on the disease. When physiotherapists, pharmacists, nurses, dentists, speech we treat human beings, we always win”, evaluates Ykeda. therapists and nutritionists) that works with these “We understand that it is not necessary to be frustrated terminal patients”, notes the coordinator. He considers with death, as long as we provide the necessary care so that the group’s work rescues the essence of Medicine. the patient can have a good life”, he adds. “In the past, doctors used to attend at home or in their ABOUT THE CAJURU small rooms. They listened to the patient, their values, they knew each one by name. At the Palliative Care UNIVERSITY HOSPITAL Commission, we seek to rescue these values: we listen The Cajuru University Hospital is a philanthropic to our patients, their families, we know their stories, institution with 100% service from the Unified knowing who they want by their side, what they want to Health System (SUS). It is guided by ethical and do with their time and what they don’t want. This is just a Christian principles and the values of the Marist small part of our work,” says Ykeda. Group. Linked to the Schools of Medicine and Life Sciences, of the Pontifical Catholic University of Paraná The therapeutic approach to palliative care also benefits (PUC-PR), values humanized care, with emphasis on doctors and other health professionals. “We can see the surgical procedures, kidney transplantation, urgency, team’s maturity in relation to death, because patients emergency, trauma and back-up care to emergency teach us many things; our experiences are unique with care and Emergency Care Units (UPAs) in Curitiba and each one of them. They teach us to value our existence cities in the metropolitan region.
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| 63 PATIENT EXPERIENCE
HOW CAN THE PATIENT EXPERIENCE method increase emotional connections in hospitals?
Although the movement of hospitals has increased PATIENT EXPERIENCE IS tremendously due to the pandemic, the greater circulation of people does not always translate into more WORLDWIDE IMPORTANT AHRQ, in its article “What is Patient Experience?”, Proves welcoming experiences for patients and for the staff of the positive association between Patient Experience, for these places. Health professionals, on the one hand, are example, caused by good communication with health working hard to meet the intense demand for hospital professionals, and important results achieved, such as care; so they face personal challenges on a daily basis, patient adherence to medical advice, better clinical such as fatigue, in addition to structural problems, such results, better patient safety practices and less use as lack of equipment. of unnecessary health services. For this reason, they On the other hand, it is not easy for patients because, defend the elevation of the patient’s experience and its in addition to being affected by the consequences of systematic measurement. the disease, a part of them receives a load of negative How can Brazilian health professionals practice the emotions due to the lack of stimuli resulting from three Patient Experience? We are adept at simplicity combined main causes: greater physical distance between patients; with positive impact. For example, providing more absence of relatives and friends in this environment; and humanizing moments in the hospital environment, also, lack of face-to-face interaction with the team from through photographs. Seeing people’s faces is one of which they are receiving care. the most important humanization experiences for all of This care with the experiences and emotions that people us. However, the use of Personal Protective Equipment experience in the health environment is called the Patient (PPE) prevents this contact, either between teams and Experience. The focus is on strengthening emotional patients, or between the hospital team itself. connections with patients and with the hospital staff, in a See this initiative created to reveal the faces of health simple and intuitive way. professionals during the Ebola outbreak in Africa in The Agency for Healthcare Research and Quality (AHRQ) 2014: the PPE Portrait Project. The rationale was that the is the leading federal agency in the United States appearance, almost “supernatural”, caused by the PPE of charged with improving the safety and quality of the the hospital staff contributed to the isolation of patients, American healthcare system. To achieve this goal, it who were afraid of space suits. These frightening effects develops knowledge and tools to help the population, diminished the ability of doctors and nurses to establish health professionals and health policy makers. trust and connect emotionally with patients. This measure demonstrated that social isolation and psychological
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suffering, on the one hand, have detrimental effects on health and recovery from the disease, and that, on the other hand, positive social exchanges substantially improve the response of the immune system.
PPE Portrait Project: initiative created to reveal the faces of health professionals during the Ebola outbreak in Africa, in 2014.
PPE Portrait Project: initiative created to reveal the faces of health professionals during the Ebola outbreak in Africa, in 2014.
Another action is the PSI Covid Project, in which This care with the experiences and professors and students from the areas of Psychiatry emotions that people experience and Psychology at the Faculty of Medical Sciences of in the health environment is called the State University of Rio de Janeiro (UERJ) encourage the Patient Experience. The focus the proximity of patients hospitalized with Covid-19 at is on strengthening emotional Pedro Ernesto University Hospital, with their families, connections with patients and with through video calls. The virtual form was decided due to the high rate of spread of this virus. the hospital staff, in a simple and intuitive way. These simple, low-cost initiatives are good examples of how emotional connections with patients can be
| 65 PATIENT EXPERIENCE
stimulated, even in a chaotic environment. Just as the 4. Truly empathize: be careful to put yourself in the Customer Experience methodology creates strong patient’s shoes and identify what he is feeling, connections between companies and consumers, the always with impartiality and compassion; Patient Experience process can also be done between healthcare teams and patients, however, with an even 5. Modulate the voice tone: the modulation of greater purpose: saving lives and reducing staff stress. the health professional voice tone can be more welcoming, especially in moments of anguish and I recommend seven effective, low-cost initiatives focused pain of the hospitalized person; on Patient Experience. They can serve as training for the teams, with the purpose of strengthening the emotional 6. Smile in another way: doctors, nurses and staff connections with patients and between the hospital who take care of exams and logistics can use the team itself: expression of the eyes and eyebrows to show affection, “smiling with the eyes”; 1. Promote humanization of care: a constant focus on humanization of care is necessary, even with 7. Taking care of communication with family adversities; members: the previous six items can be practiced with family members of the hospitalized person, 2. Understanding the strength of Patient Experience: bringing more comfort in difficult times. provenly, studying and practicing this methodology can support the recovery of patients and provide stress reduction for the teams; ROBERTO MADRUGA 3. Improve communication with the patient: one CEO of ConQuist. Consultant, professor, executive of the most important things for someone who and speaker in the areas of Customer Experience, seeks emergency services is to feel safe, so careful Customer Success, Employee Experience and Organizational Culture. Member of the Customer communication with the patient is essential; Experience Professionals Association (CXPA) and The Customer Success Association, United States. Professor at HSM and FGV.
PSI Covid Project: professors and students in the areas of Psychiatry and Psychology at UERJ encourage the proximity of inpatients with Covid-19, at Hospital Universitário Pedro Ernesto, with their families, through video calls.
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| 67 HEALTH TRENDS
THE FUTURE OF MEDICINE IS IN DIGITALIZATION
The advancement of digital technologies has caused several impacts on Medicine, especially in times of pandemic. With the high rate of contamination by the coronavirus, telemedicine has become a safer alternative for medical care. However, the digitization of Medicine is not restricted to online care. Artificial intelligence has been an important ally in urgent and emergency operations, allowing more efficient actions in cases of physical trauma. In addition, there are medical software, which optimize the professional’s routine, with the use of electronic medical records, office management and storage of the entire cloud service history.
It is undeniable that digital technologies offer lots of advantages to the health professional. And the tendency is that they become more and more popular, given the positive results observed by professionals who have already adapted to them. THE ADVANCE OF TELEMEDICINE IN BRAZIL Although it is already a practice used in several countries, telemedicine for patient care was only authorized in Brazil in April this year, due to Covid-19. The consultation takes place similarly to a face-to-face consultation, however, with the use of digital platforms, through which the doctor connects to the patient using the camera and microphone. The goal is for online care to offer the same quality and safety for both the doctor and the patient.
Telemedicine increases access to health, improves the patient experience, enhancing the promotion of care. In addition, it is possible for doctors, nurses, nutritionists,
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JAMIL CADE psychologists, physiotherapists and other health Physician for 20 years and CEO of W3.Care, a professionals to clarify the patient’s doubts and, thus, pioneering health tech and a reference in the development of technologies with artificial ensure better health for all. intelligence for urgent and emergency care. Therefore, teleconsultation will not fall out of favor after the end of the pandemic. The online service optimizes the time of the patient and the professional, being carried out in an assertive manner and with the same efficacy as a face-to-face consultation.
CLOUD CONSULTANCY One of the many advantages that technology can provide in the medical field is medical software. The office management is much simpler and more efficient, freeing the professional from all the paperwork.
The cloud office offers resources such as: scheduling by doctors and patients, electronic medical records, operational and receivables management and prescriptions, ensuring data security (the software does not depend on the use of third parties) and enabling a higher level of security, since the platform is fully aligned with the new General Data Protection Law (LGPD). In addition, health professionals have access to the online office from anywhere, through a complete digital certificate.
Telemedicine increases access to health, improves the patient experience, enhancing the promotion of care. In addition, it is possible for doctors, nurses, nutritionists, psychologists, physiotherapists and other health professionals to clarify the patient’s doubts and, thus, ensure better health for all.
| 69 HEALTHCARE BUSINESS 2020
FORUM DEBATES THE ECONOMIC IMPACT OF THE PANDEMIC ON THE REVENUE OF HEALTH INSTITUTIONS
By Felipe Nabuco Brazilian hospital network go far beyond the “absence” [email protected] of patients. “Hospital revenues have plummeted and operating costs, especially with inputs, have increased considerably. Would the return of patients alone be Debaters stress that the problems enough to help the sector?”, Questioned Leonardo faced by the Brazilian hospital Barberes. network go far beyond the According to Carlos Costa, the cash problem in Brazilian “absence” of patients due to hospitals is old. He recalls that the sector had already Covid-19 been plunged into a crisis even before the pandemic arrived, which only got worse. “At the beginning of the pandemic, some inputs increased by up to 5.000%. It The economic impact created by the Covid-19 pandemic was absurd. Between May and June, our revenue fell by on the revenues of healthcare institutions was one almost 50%. If the declines in revenues were not enough, of the issues discussed during the first day of the we still had to invest in the expansion of Intensive Care 2020 Healthcare Business Forum. Doctor Leonardo Units and in safety barrier measures”, he adds. Barberes, member of the Board of the Brazilian Hospitals Federation (FBH) and general secretary of the Although harsh and painful, the pandemic has also left Association of Hospitals of the State of Rio de Janeiro a legacy for managers across the country. According (AHERJ), mediated the discussions along with Fernando to Fernando Torelly, Covid-19 forced managers and Torelly, superintendent of Hospital do Coração (HCor), technicians to think and manage health in a new way, and Carlos Costa, CEO of the Paulo de Tarso Network of focused on more assertive and collaborative models. Continued and Integrated Care. “The challenge of hospital management, for the coming years, will be the elimination of waste and the search In its eighth edition, the Healthcare Business Forum was for efficiency. This is the great legacy that this pandemic held this year, between October 20th and 22nd, in digital leaves us”, reflects the HCor superintendent. format, due to measures to avoid agglomerations. The theme chosen for this edition - “The awakening of a new “The challenge of hospital Health” - is closely related to the Covid-19 pandemic scenario. In all, the event counted with the participation management, for the coming years, of 28 speakers, in 12 debate tables. In addition to the will be the elimination of waste and drop in revenues from health establishments, other the search for efficiency. This is the topics, such as mental health and telemedicine, were also addressed. great legacy that this pandemic leaves us”, reflects the HCor superintendent.” At the table that dealt with the emptying of health centers as a result of the Covid-19 pandemic, the panelists Fernando Torelly, recalled that the economic problems faced by the superintendent of HCor
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AHSEB IS HONORED FOR ITS 55 YEARS of service to the society of Bahia
The Association of Hospitals and Health Services of the State of Bahia (AHSEB) was one of those honored during 55 YEARS OF STRUGGLES AND the ceremony to deliver the Benchmarking Health 2020 ACHIEVEMENTS Award - the largest award in the healthcare market in the Northeast. The 10th edition of the award recognized the “AHSEB has a long history of struggles and important work performed by the entity throughout its achievements for the qualification of 55 years of foundation for the benefit of the population Supplementary Health in the state of Bahia, which is of Bahia. confused with the history of the Brazilian Hospitals Federation (FBH). As one of the Associations that The award was delivered by the president of Rede Mater decisively participated in the creation of FBH 55 Dei, Henrique Salvador, to the president of AHSEB, years ago, AHSEB has endeavored to modernize its Mauro Adan. On the occasion, Mauro Adan dedicated actions and promote significant transformations the recognition to AHSEB employees and partners and in the assistance to its representatives, always invited Dr. Lucia Dorea to, on behalf of all, receive the in line with the sector needs. In addition to the tribute for the services provided to the Bahian health FBH, AHSEB has also been involved in important segment and to associations. confrontations for better remuneration for hospital services and for a tax policy that offers adequate “I want to dedicate this deserved tribute to everyone operating conditions to the more than 2.500 who, in this long history of struggles and achievements, establishments represented in the state of Bahia. contributed to the growth of AHSEB and continue to Congratulations to all who are part of AHSEB! And contribute to the improvement of the Bahian hospital to this historic institution, our sincere wish for a long network,” said Mauro Adan. life!” - Adelvânio Francisco Morato, president of FBH
BENCHMARKING HEALTH The Benchmarking Award is one of the biggest awards in the healthcare market in the Northeast. The event, which culminates in a party night with the biggest health entrepreneurs in Bahia, is already part of the country’s Health Sector agenda.
The election of the honorees is made annually, by direct vote of businessmen, executives and other actors of the state’s Supplementary Health, in a market that moves, every year, more than R$ 6 billion. In the reference year, the winners were those who were most innovative, competent in management practices and who were willing to disclose their strategies to the market. Adelvânio Francisco Morato, president of FBH (to the left), e Mauro Adam (on the right), president of AHSEB.
| 71 CARDIOLOGY
75th BRAZILIAN CARDIOLOGY CONGRESS brings education and knowledge to 18.000 participants
Between November 20th and 22nd, the Brazilian Society In digital format, the of Cardiology (SBC) held the 75th Brazilian Cardiology event reaffirmed the Congress (CBC), considered the largest and main event in the specialty in Brazil and Latin America. The 2020 commitment of the edition, held in digital format, attracted a participating Brazilian Society of audience of more than 18.000 participants. Three days of Congress with intense scientific Cardiology to spread discussions, providing ample updates and opportunities scientific knowledge for improvement in several areas of the specialty, amid the global public health emergency scenario due to the Covid-19 pandemic was, for the president of SBC
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Marcelo Queiroga, the fulfillment of a dream, initiated by CAPACITY Dante Pazzanese and the other founders of the entity, For Professor Fausto Pinto, president-elect of the World 77 years ago. Heart Federation (WHF) and director of the Faculty of Medicine of the University of Lisbon, who participated “During this period, we reaffirm the commitment to in the event as a guest of honor, the holding of the bring continuing medical education in quality cardiology Congress, in times of pandemic, displays the strength of to all doctors in the country, and, thus, to fulfill the Brazilian Cardiology, the capacity and responsibility of the Society’s goal of contributing to the qualification of entity to, even in the face of adversities in the world, find cardiologists to reduce deaths from cardiovascular suitable solutions to maintain contact with cardiologists diseases”, stresses Queiroga. with technical knowledge and promote the exchange of information and experiences with the medical community. According to him, for more than seven decades, SBC has been building a solid scientific agenda to further The work of WHF, along with SBC and the other Cardiology strengthen Cardiology in Brazil. “The dissemination Societies in the world, was highlighted by Fausto Pinto of scientific knowledge is a perennial commitment, as fundamental to contain and face what, in his opinion, especially with the current scenario of 18 million deaths despite Covid-19, remains the great “pandemic” in the in the world every year due to cardiovascular diseases. current world: cardiovascular diseases. In Brazil, annually, there are more than 380.000 deaths from these diseases. Every 90 seconds, an individual “Like SBC, we must strive and work together to minimize dies of heart condition in the country. And that context the impact of these illnesses and seek solutions in order only got worse with the pandemic”, adds the president to find answers to develop strategies to face this great of SBC. global challenge. The 75th CBC is one of the ways to fight these diseases locally, and to be better prepared to work He recalled that the entity has been promoting more effectively for the patients and the community actions to spread scientific knowledge and build a we serve, and also to promote a healthier lifestyle, new path, through an already consolidated program since the prevention of these diseases is fundamental”, of webmeetings, since December 2019, for which highlighted the president of the WHF. more than 60.000 doctors have already participated in scientific activities. “In that spirit, the 75th CBC is the Were also present at the opening table of the 75th CBC: corollary of these achievements,” said the president. Ana Lúcia de Sá Leitão, president of the Congress, and virtually Fernando Bacal, scientific director of SBC and PUBLIC POLICIES president of the Executive Organizing Committee for Public policies to combat cardiovascular diseases were Scientific Programming (CeCon) of the event. also highlighted by Queiroga during the solemn opening of the Congress. For him, it is necessary to unite for these measures to materialize and for all Brazilians to have “The dissemination of scientific knowledge access to medical assistance and the best in Cardiology. is a perennial commitment, especially with For this, however, the commitment to have the patient in the current scenario of 18 million deaths in the center of care must be fulfilled. the world every year, due to cardiovascular “The Code of Medical Ethics says that the target of all the diseases. In Brazil, annually, there are more doctor’s attention is the patient’s well-being. This is the than 380.000 deaths from these diseases. foundation of the principle of beneficence, and it is the Every 90 seconds, an individual dies of millennial commitment of doctors. The 75th CBC has all heart condition in the country.” - Marcelo this scientific and ethical basis for integrating Cardiology Queiroga, president of SBC in Brazil,” said Queiroga. Marcelo Queiroga, president of SBC
| 73 HOSPITALITY FORUM
EVENT DISCUSSES THE IMPORTANCE OF HOSPITALITY FOR PATIENT SAFETY
The importance of healthcare hospitality for the safety information and the open channel with employees. and well-being of patients and clients was put at the Internal surveys of climate and satisfaction are also an center of the debate at the first HealthCare Hospitality excellent tool”, he added. Forum. The meeting, promoted by Equipotel in partnership with Grupo Mídia, was held in digital format Abgair Lima Honoré also recalled the difficulties that and featured lectures and debates on post-Covid-19 hospital administrations faced, at the beginning of the customer experiences. pandemic, with the scarcity of supplies and the abusive practice of prices, especially for Personal Protective The superintendent of the Brazilian Hospitals Federation Equipment (PPE). “Another challenge has been dealing (FBH), Luiz Fernando C. Silva, participated as moderator with the insecurity of employees, since many are afraid of the first table of the meeting, entitled “In times of of contracting the disease and even taking it home. In Covid-19: the importance of safe hospitality and the this period, it is important to note, we had a very high role of employees for the excellence of services”. The rate of absenteeism in hospitals,” she said. panel also counted with the participation of Marconi Morais de Freitas, Hospitality coordinator at Sabará Children’s Hospital, and Abgair Lima Honoré, Operations Superintendent at Hospital Christóvão da Gama.
Marconi Morais de Freitas presented a case about the performance of Sabará Children’s Hospital to guarantee the excellence of services at this time marked by unpredictability and transformations. He stressed that the issues of safety and quality of accommodation in hospital care have never been more in evidence than now, in this pandemic moment. “The hospitality sector plays a key role in the recovery and user experience in customer service,” he said.
When asked by the FBH superintendent, Luiz Fernando C. Silva, about what has been the biggest challenge imposed on hospital management to ensure the safety and quality of services in health facilities, Freitas highlighted the need to invest in well-defined work processes and training for the institution’s staff. “In addition, it is important to keep the focus on
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| 75 STD / AIDS
BRAZIL RECORDS 18 CASES OF SYPHILIS PER HOUR
SYMPTOMS Disease increased Syphilis manifests itself in four stages, which present different symptoms, and in the first two stages, the by 24% between symptoms are more evident and the risk of transmission is greater, while in the last stage the disease becomes 2018 and 2019, more aggressive, accompanied by complications. according to the Check it out: • Primary syphilis: appearance of a wound, between Ministry of Health 10 and 90 days, at the site of entry of the bacteria (penis, vulva, vagina, cervix, anus, mouth or other skin sites), which can disappear spontaneously; Syphilis is a dangerous sexually transmitted infection • Secondary syphilis: symptoms appear between (STI) with a risk of death if not treated properly. It is six weeks and six months after the initial wound. usually transmitted by an infected person during sexual Generally, there are spots on the body, especially intercourse; it can also be propagated in direct contact on the palms and soles. Fever, headache and with contaminated blood or vertically, that is, from the discommodity are also symptoms that can mother to the fetus. When left untreated, it can evolve spontaneously appear and regress. However, the and compromise the nervous, cardiac, respiratory, disease remains active in the body; gastrointestinal systems, and lead to death. • Latent syphilis: asymptomatic phase of the disease. In Brazil, the disease is a challenge for public health due No signs or symptoms of the infection appear. The to the considerable growth in the number of cases, which, bacteria is latent in the body; according to the Ministry of Health, was 24% between 2018 and 2019. In the beginning of 2020, 18 cases were • Tertiary syphilis: it can appear between 2 and 40 registered per hour. The progressive increase in syphilis years from the beginning of the infection, with skin is alarming, and it is increasingly necessary to implement and bone lesions, in addition to the involvement incentive campaigns for the use of condoms, the most of the central nervous system, the cardiovascular effective form of prevention for this and other STIs. system, and can lead to death.
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CONGENITAL SYPHILIS
Syphilis is especially dangerous if the infected person is a pregnant woman. According to estimates by the World Health Organization (WHO), in 2016, there were more than half a million cases of congenital syphilis in the world. The disease is transmitted vertically, from the infected mother to the fetus, with a high mortality rate, spontaneous abortion, stillbirth, low birth weight, prematurity, neurological sequelae and neonatal death.
Transmission can occur at any stage of pregnancy; however, the more recent the infection in the pregnant woman, the more severely the fetus can be reached. Therefore, it is essential to make the diagnosis early, to start the treatment that will guarantee the health of the mother and the child.
The diagnosis is made by means of a blood test or material taken from the lesions, and the treatment is carried out with laboratory tests that identify the evolution of the disease, to be prescribed antibiotics with medical monitoring.
The safest way to prevent it is to use a condom during sexual intercourse.
| 77 TRIBUTE
BRAZIL SAYS GOODBYE TO ONE OF THE GREATEST LEADERS AND SCHOLARS OF THE HEALTH SECTOR
Representative entities paid last tribute to the doctor Olympio Távora, author of important books and a tireless voice in the fight for the improvement of the Brazilian health system
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Brazil said goodbye, on December 23rd, on Christmas Association of Hospitals of the State of Ceará (AHECE) and eve, to one of the greatest leaders and scholars in the general secretary of FBH. Health Sector. Respected for his technical positioning, polished for 62 years of uninterrupted work at the “Dr. Olympio represents the history of the Brazilian hospital head of various bodies linked to the sector, the doctor chain and the health system, always seen from the inside. Olympio Távora Derze Correa will be missed, in addition Thank you very much for your contributions, Dr. Olympio”, to an immense gap in militancy for the improvement of also highlighted Manoel Gonçalves Carneiro Netto, the Brazilian Hospital Sector. president of the Association of Hospitals, Clinics and Service Providers in the Health Area of Espírito Santo (AHCES). A great scholar, Olympio was a tireless leader. As a doctor specialized in Hematology and Hospital Administration, “Olympio, for me, will always remain alive. My father, my he provided community care, worked in public and friend, my teacher, my advisor, my mentor in the Health private hospitals, and he was a prominent voice in the Sector. He made me understand what the Health Sector struggle to build a just and efficient health system for the is, what the Federation is, what the hospital is, what my Brazilian population. He was a member of the National job is and what my responsibility is given the importance Health Council (CNS), general secretary of the Brazilian of the country’s segment and hospital network. He is Society of Hematology and Hemotherapy (SBHH) and the person who really made a difference in the history consultant of representative entities of the Hospital of health in Brazil”, said Luiz Fernando Corrêa Silva, Sector, such as the Brazilian Hospitals Federation (FBH). superintendent of FBH.
In 2016, Olympio published the book “A century of health in the country: advances and setbacks”. At the time, he recalled that the publication brought together important memories of the period in which he not only followed, but was also an active player in the construction of the Brazilian health system. He participated in numerous debate forums and signed several articles published in important journals on topics such as hospital evolution, remuneration models, construction and financing of the Unified Health System (SUS), in addition to changes in medical education.
TRIBUTES Olympio Távora passed away due to Covid-19. Great national leaders mourned the loss of the eternal master. He knew every step of this historic construction process and presented himself as a scholar and in-depth knowledge of advances, as well as the problems and adversities faced by the Health Sector. His performance will leave a gap difficult to fill”, highlighted Adelvânio Francisco Morato, president of the Association of Hospitals of the State of Goiás (AHEG) and FBH.
“Olympio has dedicated a large part of his life to defending health in Brazil and, in particular, the cause of hospitals. There is no doubt that, for us, health managers, it is an irreparable loss, especially for those who lived with him”, said Luiz Aramicy Bezerra Pinto, president of the
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| 81 HAPPENING AT THE CONGRESS
Dulci Tiné FBH Parliamentary advisor
RENEGOTIATION OF TAX DEBTS THE HEEL-STICK TEST
The Bill 2.735/2020, drafted by Congressman Ricardo Legislator Sergio Vidigal (PDT/ES) presented Guidi (PSD/SC), is passing through the Chamber of Bill 4.202/2020, which requires hospitals Deputies, which creates a new tax and non-tax debt and maternity hospitals to advise parents installment program, along the lines of Refis, to minimize on rare diseases, not detectable by the the impact of the Covid-19 pandemic in the economy. The National Neonatal Screening Program purpose of the Extraordinary Tax Regularization Program (newborn screening), face-to-face and in an (Pert/Covid-19) is to allow companies and individuals in easy language. Nowadays, the heel-stick debt to the Income Tax on Individuals or with the General test is performed to identify some other Attorney of the National Treasury (PGFN) to regularize the diseases; however, many parents do not test tax and non-tax debts of the taxpayer generated up to their children because they are unaware of the month of competence in which the end of the state of its importance. The idea is to promote an public calamity is declared. The proposal will be analyzed expanded test. The project still needs to be by the Finance and Taxation and the Constitution and distributed for processing in the Commissions Justice and Citizenship Commissions. of the Chamber of Deputies.
PARLIAMENTARY FRONT OF TELEHEALTH
On November 25, the Brazilian Hospitals Federation became Law No. 13.989/2020, which authorizes (FBH) attended the launch of the Parliamentary the use of telemedicine during the state of public Front of Telehealth, which aims to discuss the calamity. She explains that health is not restricted provision of health services at a distance, using to medical appointments, but also to other areas, smartphones or computers. This assistance model such as Nutrition, Psychology, Physical Preparation, is gaining more and more strength, especially at among others. The Front intends to open space for this time of the new coronavirus pandemic. Deputy the debate on the subject with civil society, entities, Adriana Ventura (Novo/SP) was elected to the hospitals, councils and public authorities. Presidency of the Front, author of the project that
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MIXED PARLIAMENTARY FRONT FOR STRENGTHENING SUS
Created by more than 200 parliamentarians - 187 resources to expand, with quality, the service and deputies and 15 senators -, the new Front aims to the improvement of the system after the pandemic. expand budgetary resources for structuring public It was created from the initiative of Deputy Márcio health, in order to improve the quality of patient care, Jerry (PCdoB/MA), who is to preside over the Front, especially in the post-pandemic period. The Front and Senator Weverton Rocha (PDT/MA). intends to develop actions that ensure sufficient
SUS REFORM
One of the reforms necessary for the country’s growth For the analysis of the Draft Laws in progress in and which is taking shape is that of the Unified Health the Chamber of Deputies dealing with SUS and the System (SUS). The Covid-19 pandemic showed the elaboration of a proposal aimed at strengthening importance of SUS and indicated that a reform should and modernizing the System, a Working Group (WG) integrate the tripod of those considered essential for was created to be coordinated by Congresswoman the resumption of the country’s economic growth, Margarete Coelho (PP/PI). combined with the tax and administrative sectors.
2020/2021 CONGRESS RULES
The National Congress did not reach an agreement to created the Casa Verde e Amarela Program and the put on the agenda the necessary reforms to promote Bill that increases competition in so-called cabotage, economic development, mainly to help overcome waterway transport between ports, leaving the most the post-pandemic. After municipal elections, controversial issues for 2021 - fiscal adjustment and parliamentarians should focus on two projects on administrative reform. the 2020 agenda: the Provisional Measure (MP) that
| 83 EVENTS CALENDAR
HEALTH SECTOR EVENTS 2021 CALENDAR
JANUARY APRIL
SAHE – SOUTH AMERICA HEALTH EDUCATION 3rd CONDEPE - CONGRESS OF PROFESSIONAL Date: January 26th to 28th DEVELOPMENT IN NURSING Location: Anhembi Event Center – São Paulo-SP Date: April 6th to 7th Site: https://grupomidia.com/sahe/ Location: Transamérica Expo – São Paulo-SP Site: https://www.condepe.com.br/
MAY MAY
MEDICAL FAIR BRASIL HOSPITALAR FAIR Date: May 4th to 7th Date: May 18th to 21st Location: Expo Center Norte – São Paulo-SP Location: São Paulo Expo – São Paulo-SP Site: https://www.medicalfair-brasil.com.br/pt/ Site: www.hospitalar.com/pt/home.html
JUNE JUNE
FCE PHARMA 21st BRAZILIAN CONGRESS OF PEDIATRIC Date: June 8th to 10th INFECTOLOGY Location: São Paulo Expo – São Paulo-SP Date: June 16th to 19th Organization and Promotion by: NürnbergMesse Location: Brasil 21 Convention and Events Center– Brasília-DF Site: https://www.fcepharma.com.br Realization by: Brazilian Pediatrics Society (SBP) Site: https://www.sbp.com.br/especiais/congresso-de- infectologia-pediatrica-2021/
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SEPTEMBER SEPTEMBER
VI COBRAFIN (CONGRESSO BRASILEIRO DE EXPO-HOSPITAL BRASIL FISIOTERAPIA NEUROFUNCIONAL) Date: September 3rd to 6th Date: September 28th to 30th Location: Brasil 21 Convention and Events Center– Location: Expominas – Belo Horizonte-MG Brasília-DF Site: https://expohospitalbrasil.com.br Realization by: Brazilian Association of Neurofunctional Physiotherapy (Abrafin) Site: https://www.cobrafin.com.br
OCTOBER OCTOBER
GLOBAL SUMMIT TELEMEDICINE & DIGITAL HEALTH HOSPITALMED Date: October 5th to 7th Date: October 20th to 22nd Location: São Paulo-SP Location: Pernambuco Convention Center – Recife-PE Realization by: Transamérica Expo Center Realization by: HospitalMed Site: http://telemedicinesummit.com.br Site: https://hospitalmed.com.br/feira/
NOVEMBER
11th BRAZILIAN CONGRESS OF EPIDEMIOLOGY Date: November 13th to 17th Location: Fortaleza-CE Realization by: Brazilian Association of Public Health (Abrasco) Site: https://epi.org.br/index.php
| 85 ECONOMIC INDEX WORKSHEET
INFLATION INDEX (%) PERIOD MONTHLY 12 MONTHS IPCA - % NOVEMBER/2020 0,89 4,31 INPC - % NOVEMBER/2020 0,95 5,20 IPCA-15 - % DECEMBER/2020 1,06 4,23 IPC Fipe - % DECEMBER/2020 0,79 5,62 IGP-M - % DECEMBER/2020 0,96 23,14 IGP-DI - % NOVEMBER/2020 2,64 24,28 IGP-10 - % DECEMBER/2020 1,97 24,16 Sources: IBGE, Fipe, FGV and Dieese. Elaboration: Valor Data.
APPLICATIONS INDEX IN % Selic over, per year 1,90 CDI over Cetip, per year 1,90 DI Futuro, per year (jan/22) 2,98 TR (Jan 07th) 0,0000 TBF (Jan 07th) 0,1583 Previous Savings (07/01) 0,5000 Current Savings (07/01) 0,1159 Sources: Banco Central and B3. Elaboration: Valor Data.
FIPE HEALTH MONTH YEAR % October 2020 0,02 November 2020 0,25 December 2020 0,33
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