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Acess the online magazine VISÃO HOSPITALAR MAGAZINE THE IMPORTANCE OF THE HOSPITAL The hospital is a medical and social organization whose function is to provide the entire population with comprehensive, curative and preventive medical care, in addition to being a center for education and research in health. The current scenario has placed the hospital in the center of all attention, as it recognizes its importance and role at this time and knows how we really need this attention. For some time now, we have demonstrated the situation faced by hospitals, such as the high tax burden, the request for special credit lines, the need for qualification of all professionals working in the segment, the importance of innovation and technology for the entire chain, and , in the midst of all this struggle, there is a much bigger challenge: the search for adequate treatments and procedures, as well as qualified labor to face this challenge that is the coronavirus. The Health Sector requires more than investment and attention; it requires planning to remain one of the most promising areas for the development of our economy and the country. We need to strengthen all hospitals, expand the number of beds in our country and the capacity to provide care for each one, so that we can provide safe, qualified and adequate care for our population. Adelvânio Francisco Morato President of FBH As a pioneer entity in the representation of Brazilian hospitals, FBH has been leading, alongside partner institutions, historical claims that, at this moment, require special attention. WORD FROM THE PRESIDENT We will continue on this journey, joining efforts with the main institutions and authorities that operate in the segment to effectively contribute to the development of our hospitals and professionals. Congratulations to all professionals and hospitals who are standing strong in their mission! Adelvânio Francisco Morato President of FBH EXECUTIVE BOARD PRESIDENT Adelvânio Francisco Morato GENERAL SECRETARY Luiz Aramicy Bezerra Pinto CULTURAL ACTIVITIES’ DIRECTOR SUPERVISORY BOARD - ALTERNATE MEMBERS Roberto Vellasco Maurício Souto Maior Benno Kreisel Marcus Camargo Quintella <ul style="display: flex;"><li style="flex:1">VICE-PRESIDENT </li><li style="flex:1">DEPUTY SECRETARY </li></ul>Altamiro Bittencourt Eduardo de Oliveira Manoel Gonçalves Carneiro Netto Reginaldo Teófanes de Araújo Francisco José Santiago de Brito José Pereira Mauro Duran Adan Élson Sousa Miranda Ivo Garcia do Nascimento SUPERINTENDENT Luiz Fernando C. Silva DIRECTOR TREASURER Mansur José Mansur BOARD DIRECTORS ADVISORS Leonardo Rocha Machado Ibsen Pontes Moreira Pinto SUPERVISORY BOARD - EFFECTIVE MEMBERS Fernando Antônio Honorato da Silva e Souza Leonardo Gigliotti Barberes Edivardo Silveira Santos DEPUTY TREASURER Glauco Monteiro Cavalcanti Manso |3EXPEDIENT Viviã de Sousa - 12118/DF <a href="mailto:[email protected]" target="_blank">[email protected] </a>WORD FROM THE EDITOR Chief editor Graphic Project Viva Comunicação Group vivacomunicacaogroup.com Overcoming a crisis In commemoration of National Hospital Day and World Hospital Day, in this edition we deal with the scenario of the evolution of this important establishment for our segment and for the whole country. Marketing <a href="mailto:[email protected]" target="_blank">[email protected] </a>Executive production Rosana Oliveira <a href="mailto:[email protected]" target="_blank">[email protected] </a>We also interviewed senator Izalci Lucas (PSDB/DF), who spoke about one of the greatest lessons learned from the pandemic: the importance of investment in health and how this crisis mainly affected small and medium-sized hospitals in Brazil. Translation and Proofreading Jaqueline Rodrigues Guilherme Franco Santos Content production Felipe Nabuco <a href="mailto:[email protected]" target="_blank">[email protected] </a>The portrait of the Brazilian hospital network, made by Luiz Fernando C. Silva, superintendent of the Brazilian Hospital Federation (FBH), demonstrates the effects of the pandemic on the management of service providers and the numerous challenges faced by the entire sector. Print run 7 mil exemplares Art and Layout Viva Comunicação Group vivacomunicacaogroup.com And when it comes to investment, we present the fund created by Bioxxi, the largest company in Latin America in the sterilization of health products, which aims to help hospitals in this moment of crisis aggravated by the pandemic. Publication Quarterly Overcoming this crisis is due to the effort of all those who went beyond their limits to promote actions, paths and opportunities that would contribute to the development and solution of the problems facing the area. Our goal is to promote strategic content to help our readers visualize new horizons. Federação Brasileira de Hospitais - FBH SRTVS Qd. 701 - Conj E - nº 130 - 5º andar Ed. Palácio do Rádio I - Torre III - Brasília-DF 70340-901 Tel: (61) 3044 0332 ENJOY YOUR READING Viviã de Sousa | Chief Editor E-mail: [email protected] ARTICLES AND REPORTS GESTÃO DA QUALIDADE CANNABIS MEDICINAL VISÃO INTERNACIONAL HOSPITAL REFERÊNCIA GESTÃO DE PROJETOS AHEG 08 10 12 18 20 25 30 32 34 36 38 40 42 45 47 GESTÃO DE PESSOAS INTERNACIONAL INOVAÇÃO GESTÃO MARKETING COVER MEDICINA DIAGNÓSTICA NEGÓCIOS TRANSFORMAÇÃO <ul style="display: flex;"><li style="flex:1">HOSPITALAR </li><li style="flex:1">06 </li></ul>22 15 27 REDE HOSPITALAR ENTREVISTA VISÃO JURÍDICA PLANOS DE SAÚDE INVESTIMENTO INOVAÇÃO E SAÚDE TELEMEDICINA 49 51 SAÚDE DIGITAL FALA GESTOR ENERGIA 54 56 58 EVENTS AND INDICATORS ACONTECE NO CONGRESSO CALENDÁRIO DE EVENTOS ÍNDICES ECONÔMICOS 60 62 64 HOSPITAL TRANSFORMATION HOSPITAL TRANSFORMATION IN THE COURSE OF THE PANDEMIC By Felipe Nabuco <a href="mailto:[email protected]" target="_blank">[email protected] </a>to changes, which permeated the transformations in care and in the organization of health services. Organizational resilience, adaptability, technological The scenario of crowded emergencies, patients dying while waiting for beds, overworked professionals, shortage of supplies and medicines, among others, was one of the biggest challenges ever imposed on the Brazilian health system. Added to this context is the need to face an enemy that is still little known, as well as its destructive power. incorporation and investment in people training. How are hospitals reinventing themselves during the worst time of health crisis in centuries? Farbeyondtechnologicalinnovations,itwasnecessary for hospitals to also look inwards, to the way they The pandemic caused by the new coronavirus catalyzed changes in care and hospital management, which have long been identified as necessary by the sector itself. An example of this is the incorporation of digital technologies that have become realities in hospitals around the world for more than two decades, but were left aside in Brazil. manage, analyze and optimize internal processes, how the existing methods and methodologies work and are adapted to institutional scenarios and cultures. For those who had nowhere to look for inspiration, it was necessary to seek solutions within the current scenario. And this was one of the biggest challenges posed by the crisis: how to do more and better with the same, or even with less? However, this accelerated modernization process, as expected, did not linearly encompass the entire Brazilian hospital network, which today is mostly (70%) composed of small and medium-sized hospitals. In most of these establishments, it was not technology, but the very ability to reinvent and adapt The ability to adapt to changes, as well as organizational strength and resilience, led the sector to redefine organizational flows, to adopt new care protocols, to force discussion about the difficulties faced by the economic and industrial health 6|VISÃO HOSPITALAR MAGAZINE “Transforming current problems into opportunities for improvement, so that hospitals can leave this pandemic with more management maturity, especially with regard to people's preparation, organizational resilience and capacity for change, is still the greatest challenge.“ complex, which lead to the proper functioning of the several countries, these technologies have been a production chain, as well as to invest significantly in reality since the 1990s. the training of professionals. This accelerated digital transformation, however, One of the immediate consequences of this process also reveals imminent challenges for the Brazilian is the strengthening of safety protocols against hospital network. One of them concerns the hospital infection, as well as the dissemination of urgent adaptations to the General Data Protection collective self-awareness for preventive actions, Regulation (In Portuguese, Lei Geral de Proteção de such as attention to hand hygiene, care with the use Dados - LGPD). Another challenge shows that it will be <ul style="display: flex;"><li style="flex:1">of masks, among others. </li><li style="flex:1">necessary to implement a State policy that mitigates </li></ul>the consequences of the abyss that only increases between small and medium-sized establishments and large hospital complexes. In relation to professional qualification, the moment of crisis also showed how essential it is to have trained professionals ready to coordinate, both in the care and management areas, teams in such It is a fact that the country needs to recognize the adverse situations, especially during peak moments strategic and sustainable importance that these small of the pandemic. Establishing training routines and establishments have for the national health system, preparing leaders became an ongoing strategy in the especially in inner cities, where they are the only planning of each establishment as a way to prepare care option for millions of Brazilians (seven out of <ul style="display: flex;"><li style="flex:1">for unpredictable situations. </li><li style="flex:1">ten are located in cities from the interior). Today, they </li></ul>represent about 70% of all hospital establishments in the country, and more than half perform care as service providers by the Unified Health System (SUS). The much-talked-about incorporation of technology, ofcourse, alsoenabledsignificantimpactsonhospital transformation. From the perspective of the debate, it would not be an exaggeration to say that Brazil has Every moment of difficulty can bring reflection managed to achieve more in this single year than the and learning. Transforming current problems into last 30 years combined. At least, this is the period opportunities for improvement, so that hospitals can in which important themes in hospital care, which leave this pandemic with more management maturity, are now gaining prominence, such as telemedicine, especially with regard to people's preparation, electronic medical records and digital self-service organizational resilience and capacity for change, is systems, have been discussed in different fields. In still the greatest challenge. |7QUALITY MANAGEMENT PATHS TO EXCELLENCE IN HEALTH Health care requires new approaches, in which the generation of value for citizens is an essential criterion in any care provided. RAFAELA VERONEZI Physiotherapist, PhD in Medical Sciences, corporate manager of Teaching and Research at the Association for Management, Innovation and Results in Health. In organizations of any nature, excellence does not happen instantly. In health, this reality is no different. The high standard involves issues related to assistance that obviously permeate management. It is a gradual process, a path that must be followed with determination and obstinacy. end, as it involves continuous improvement and there is no guarantee of its continuity. Implementing improvements requires more than good ideas and good will. It takes an attitude for the constant improvement of processes and the acumen of change to carry out things, under penalty of being <ul style="display: flex;"><li style="flex:1">stuck with pre-established and outdated models. </li><li style="flex:1">This does not mean that all health institutions have a </li></ul>similar trajectory. On the contrary. We have observed, historically, that several entities do not start at exactly the same point and do not reach the same parity. Each one builds its own path and has its own evolution time, depending on the maturity of its management. Currently, in healthcare organizations, the pursuit of excellence is focused on improving the experience of patients, with greater cost-effectiveness. It means to say that the services must be prepared to meet the population's health demands with quality and safety, observing the priorities and assistance profile of each unit. However, the most important perception is the understanding that we must act seeking excellence, knowing that this is not an absolute and immutable 8|VISÃO HOSPITALAR MAGAZINE In this case, the focus on the user's needs comes costs, meteoric technological advances, in addition to first, and the consequences of this end up generating regulatory pressures, make the pace of transformation improvements in all aspects involved. That is, it is slower than desirable. necessary for professionals to see the importance of In healthcare, as in any other professional area, there is no guarantee of excellence without hard work. We need to generate information from concrete data and consistent structures. More and more, we need to awaken, in the health teams, the interaction to play the empathic dimension, in which human relationships are defined not only in the provision of services, but in the delivery of value, prioritizing results from the perspective of the protagonist of care: the patient. As long as health is seen as just an expensive budget a leading role with all the characters working in the item, its policies will be seen as short-term investments. system – which is complex, but rewarding, as it handles Health care requires new approaches, in which the and saves countless lives. generation of value for citizens is an essential criterion Here comes a new era… the road ahead is treacherous. in any care provided. But how to get there? It is only achievable with a lot of dialogue, teaching Implementing any organizational change is particularly and research, humanization and love for the patient. challenging; however, it is perfectly possible and Only then we will be able to make tangible changes to feasible. However, limited financial resources, rising our healthcare system, of which we are all users! |9MEDICINAL CANNABIS THE PAST OF AN ANCIENT ART. THE PRESENT AND FUTURE OF A FASCINATING SCIENCE The medicinal use of cannabis has been known in many cultures for more than 5.000 years, taking us back to the era that precedes the written word. We know that cannabis traveled the entire Silk Road that commercially connected the East and Europe, being taken to the West by the Scottish physician William O'Shaughnessy while participating in the British missions in the Indies. Despitetheunfavorablebackdrop, scientistscontinued to study the use of medicinal cannabis as an adjunct therapy in the treatment of neurological, psychiatric, degenerative and inflammatory diseases. Known as the “father of modern cannabis”, researcher Raphael Mechoulam, in partnership with the Hebrew University of Jerusalem, managed to isolate 60% of the active substance in cannabis with laboratory methods synthesizing, for the first time, THC (tetrahydrocannabinol) and, later, cannabidiol, compounds of the plant. His study, published in the journal Science in 1970, approaches the biogenesis of cannabinoids in an unprecedented way. As a researcher and professor at the University of Calcutta (India), William O'Shaughnessy was one of the pioneering scientists in the research of cannabis therapies in patients with cholera, rheumatism, rabies, tetanus, epilepsy and inflammatory diseases, studying the substance's benefits in the pain relief and reduction of muscle spasms. The discovery and elucidation of the endocannabinoid system allowed for a wide range of preclinical studies to be carried out, enabling the first clinical trials in the area to be conducted. In 1980, Raphael Mechoulam and Brazilian professor Elisaldo Carlini, from the Federal University of São Paulo (Unifesp), together published the first study with humans on the use of medicinal cannabis in patients with drug-resistant epilepsy, demonstrating the substance's benefits in controlling epileptics seizures. The use of medicinal cannabis gained prominence in Europe and, later, in the United States, between the years of 1840 and 1940. English doctors indicated the use of the plant as an appetite stimulant, analgesic, muscle relaxant, anticonvulsant and hypnotic. However, due to ideological and political issues, as well as the lack of quality control and basic knowledge of the pharmacology and chemistry of the plant, cannabis went through a period of obscurantism in the last century, being banned in many countries, especially by the growth of its recreational use. More than a century after the publication of the first works of Modern Medicine with medicinal cannabis, we know that the plant has more than 480 chemical 10 |VISÃO HOSPITALAR MAGAZINE substances. About 150 of these compounds are by multiple sclerosis, in the control of epileptic seizures called phytocannabinoids, and the best known and and other conditions. These benefits have significantly most studied are THC (tetrahydrocannabinol), CBD contributed to the quality of life of patients. (cannabidiol) and CBG (cannabigerol). The advancement of scientific knowledge about Sciencehasalreadydiscoveredthatphytocannabinoids medicinal cannabis and the development of the bind to specific receptors in the human body. This specialized pharmaceutical industry show that we are complex system is responsible for a number of facing an innovative scenario in which the substance physiological functions, including memory, mood, can be classified as a new therapeutic area available to motor control, eating behavior, sleep, immunity and support different medical specialties. Cannabis-based pain. Thus, studies show the benefits of treatment for phytopharmaceuticals are developed through rigorous certain diseases, such as in the non-motor symptoms quality controls, with 99% purity and defined indications of Parkinson's disease (depression, anxiety, sleep that can respond to the unmet needs of patients. disorders and others), in the pain and spasms caused FLAVIO REZENDE Studies show the beneﬁts of treatment Master and Doctor in Neurology. Professor at for certain diseases, such as non-motor the Department of Clinical Medicine at the symptoms of Parkinson's disease (depression, anxiety, sleep disorders and others), in the pain and spasms caused by Federal University of Rio de Janeiro (UFRJ) and Director of Research and Development at Health Meds. multiple sclerosis, in the control of epileptic seizures and other conditions. |11 INTERNATIONAL VISION THE ORGANIZATION OF THE GERMAN HOSPITAL SYSTEM AND ITS PERFORMANCE IN THE FIGHT AGAINST COVID-19 A fundamental facet of the German healthcare system The DKG bundles and advocates their interests in in general and the hospital sector in particular is all health politics at the national, European and the sharing of decision-making and responsibilities International level. On the other hand, the DKG was between the federal, the regional, and the local level. and is assigned with a continuously growing list of At each level, various actors interact to fulfil specific responsibilities with regard to the principle of selfduties to their respective role. Whereas the on-site governance. organisation and planning of hospital care remain the The objective of this article is not to decode the complex multi-layered German healthcare system, but to provide you with a first overview. The report starts with a look at the German hospital landscape that exclusive responsibility of the regional and local level, main issues to decide on the national level are quality standards and financing mechanisms. At the national level, the government and parliament helps us, in the second part, to reflect on Germany’s set basic definitions and objectives by Federal law and COVID-19 response in 2020. the actors of the “self-governance system” –healthcare providers and health insurance providers sickness funds – negotiate and decide on the binding details. GERALD GASS In this very complex multi-layered healthcare system, the German Hospital Federation (DKG – Deutsche Krankenhausgesellschaft e.V.) is the representative body of all German hospitals regardless of their type of ownership. Public, private-for-profit and privatenot-for-profit, or charity based hospital owners are united in the DKG via its member organisations.

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