{"id":4219,"date":"2024-03-11T19:15:59","date_gmt":"2024-03-11T22:15:59","guid":{"rendered":"https:\/\/rededor2023.blendon.com.br\/capital-social-e-de-relacionamento\/nossos-pacientes\/"},"modified":"2024-07-10T18:45:13","modified_gmt":"2024-07-10T21:45:13","slug":"our-patients","status":"publish","type":"page","link":"https:\/\/rededor2023.blendon.com.br\/en\/social-and-relationship-capital\/our-patients\/","title":{"rendered":"Our patients"},"content":{"rendered":"\n

Social and Relationship Capital Highlights<\/h2>\n\n\n\n
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88%<\/sub><\/p>\n\n\n\n

OF OUR HOSPITALS<\/p>\n\n\n\n

are accredited with excellence (ONA3 or international certification).<\/p>\n<\/div><\/div>\n\n\n\n

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1.6<\/p>\n\n\n\n

million BENEFICIARIES<\/p>\n\n\n\n

direct and indirect in social projects<\/p>\n<\/div><\/div>\n\n\n\n

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44<\/p>\n\n\n\n

HOSPITAlS<\/p>\n\n\n\n

were awarded the Top Performer ICU and Efficient ICU certifications<\/p>\n<\/div><\/div>\n\n\n\n

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R$ <\/sub>17,5<\/p>\n\n\n\n

million INVESTED <\/p>\n\n\n\n

in social projects<\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n<\/div><\/div>\n\n\n

Note: In this chapter, we provide a contextual view of impacts identified in the impact assessment process for the Economic Performance theme. To this end, the relevance of these impacts for our business, their management and effectiveness measures and involvement with stakeholders were described contextually. The real positive impacts were contextually reported, namely: Improvement of care and infrastructure of the Brazilian health system (pages 88 to 98); Creating jobs, collecting taxes and stimulating the economy (pages 105 and 106); and supplier development (pages 99 to 102). We identified the real negative impact as \"Impacts arising from suppliers' lack of adherence to ESG requirements (pages 99 to 102) [GRI 3-3].<\/p>\n\n\n\n

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Patient-centered care<\/h2>\n\n\n\n

GRI 2-6, 3-3<\/p>\n\n\n\n

Ensuring the best possible experience for our patients and their families during their stay with us is part of Rede D\u2019Or\u2019s commitment. To this end, we have adopted a care model in which the patient is at the center of everything by receiving our Core Business services, making up the downstream in our value chain [GRI 2-6]. Therefore, we have adopted a care model where the patient is at the center of everything. A multidisciplinary team led by a medical team is devoted to achieving the expected outcome while monitoring the technical quality of assistance care and service satisfaction. Our ultimate goal is to achieve the desired financial performance while creating value for our users.<\/p>\n\n\n\n

We maintain a Patient-Centered Care Policy\u2014described by a working group\u2014as recommended by the Joint Commission International (JCI) methodology, and a Patient Experience Committee that continuously works on developing strategies for improving patient\u2019s experience, as well as that of their families, and company\u2019s employees. To this end, the Committee relies on perceived quality information and interactions with institutional leaders and medical records, palliative care, and mortality committees. Projects are implemented by working groups focused on the theme.<\/p>\n\n\n\n

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Hospital Estadual da Crian\u00e7a <\/em>(Children\u2019s Hospital)<\/h4>\n\n\n\n

Managed by Rede D\u2019Or S\u00e3o Luiz since 2013, Hospital Estadual da Crian\u00e7a celebrates 10 years of excellence in pediatric care. Located in Vila Valqueire, in Rio de Janeiro\u2019s Western Region, the unit is a reference in transplants and oncology and surgical treatments and has already provided care for more than 250,000 patients.<\/p>\n\n\n\n

The hospital is a partnership entered into the company and the Rio de Janeiro State Health Department in 2012, to manage this new unit through D\u2019Or Institute of Public Health Management. The Children\u2019s Hospital is housed in the building of the former Hospital Rio de Janeiro\u2014a private unit of Rede D\u2019Or\u2014which was provided by the company to provide public services to SUS patients through a Social Health Organization (OSS, in Portuguese). The hospital is the first pediatric unit in Rio de Janeiro focused on high-complexity surgical procedures and features modern facilities, fully adapted for pediatric care. Patients are referred to Hospital Estadual da Crian\u00e7a through the Rio de Janeiro State Regulatory System, as it does not provide emergency care.<\/p>\n<\/div><\/div>\n\n<\/div><\/div><\/div><\/div>\n\n<\/div><\/div>\n\n\n

The high volume of patient care continued to impact our Net Promoter Score (NPS) in 2023, which, although higher than that of the previous year (59 versus 56 in 2022), is still below our 2021 score, which was 64. We remain committed to achieving the NPS zone of excellence in all Star hospitals by 2030. We rely on the support of our Ombudsman Office, which operates with the units in an advisory model to help with recovery when a drop in NPS is identified and we are implementing a series of actions to consolidate the patient experience culture within the Company. In 2023, we resumed growth in NPS and other perceived quality indicators, which are directly affected by the high volume of patient care of the units. As recognition of our efforts, we have once again been nominated for the Experience Awards, which certifies companies with the highest NPS in Brazil [GRI 2-25, 3-3].<\/p>\n\n\n\n

Seeking continuous improvement in our services, we also rely on tools to assess patient and employee satisfaction and to monitor healthcare quality indicators. Examples are managerial reports (Pearson correlation, HCAHPS and segmented IS indicators) showing detailed data in order to facilitate the identification of failures and, consequently, improve our performance level. In 2023, we developed dashboards to better manage our area indicators and invested in upgrading Requestia, a specific demand management tool, which allowed us to refine case typology, integrate with survey software, and develop a system for managing improvement actions. In an unprecedented initiative, in 2023, we also established an advisory board with clients for the co-creation of service journeys [GRI 2-25, 3-3].<\/p>\n\n\n\n

Since 2015, hospital units have had improvement committees involving clinical and support teams, aiming to jointly evaluate customer feedback received through the ombudsman, satisfaction survey indicators, and testimonials to propose strategies and improvement actions for better service delivery to patients.<\/p>\n\n\n\n

Between January and December 2023, we reached the milestone of over half a million surveys answered by our users. We received 104,625 demands through our Ombudsman Office, including complaints, compliments, and suggestions. Of this total, 79,687 were complaints, all addressed and returned to the customer [GRI 2-25, 3-3].<\/p>\n\n\n\n

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Transplants<\/h4>\n\n\n\n

For many people, organ transplantation is the only chance for treating their illnesses and having a better quality of life. Therefore, as a transplant reference center in Brazil, we have published an Organ and Tissue Donation Manual, available on our website, to inform families and guide them through the entire process, from the organization of the National Transplant System to the clinical tests required to identify potential donors. Our hope is to contribute to increasing organ donation in Brazil and to save lives through them.<\/p>\n\n\n\n

We have an extensive transplant program within our network \u2014 kidney, lung, heart and liver \u2014 for which we provide a comprehensive set of patient guidance materials for transplant candidates and transplant recipients. In 2023, our kidney transplant program achieved the historic milestone of 150 procedures performed by Hopital S\u00e3o Rafael, one of our few accredited and authorized centers for the procedure in the state of Bahia. Meanwhile, the heart transplant program, established in 2017, gained the participation of Hospital Copa D\u2019Or, which received certification and authorization from the Brazilian Ministry of Health to perform the procedure in 2023, the same year the unit also completed its first lung transplant.<\/p>\n<\/div><\/div>\n\n\n\n

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Patient Safety<\/h3>\n\n\n\n

GRI 3-3, 416-1, 416-2<\/p>\n\n\n\n

Our patient safety policy is in line with the six international patient safety goals set by the World Health Organization (WHO) and the guidelines of the National Patient Safety Program. Supported by a risk monitoring and management system, we identify events in patient care and implement measures to minimize the occurrence of adverse events, strengthening a safety culture across all our hospitals.<\/p>\n\n\n\n

We assess the impacts on patients\u2019 health and safety in all of our services using indicators set by the WHO, which are regularly monitored by the healthcare teams. One of the tools we use is the continuous monitoring of recorded adverse events, such as a patient falling during an examination or incorrect medication dosage. All hospitals must report such events for proper analysis and the establishment of an action plan to minimize their occurrence. Harm caused to patients by unsafe care is a significant, growing global health challenge and one of the leading causes of death and disability worldwide. Notably, most of this harm is preventable.<\/p>\n<\/div><\/div>\n\n\n\n

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During the period, 707 hospitals in Brazil took part in the Brazilian ICUs project, of which 58 (8%) are from the Rede D\u2019Or. Among the 234 ICUs recognized as Top Performers, 78 (33%) are from the Rede D\u2019Or, i.e. one in three ICUs awarded the distinction are ours.<\/strong><\/p>\n\n\n\n

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In 2023, we recorded 156 cases of non-compliance with laws related to impacts on health and safety that resulted in penalties, with 82 cases of medical errors and 74 cases of service delivery failures. The increase in cases compared to the previous year (62 in 2022) can be explained by the backlog of judicial decisions caused by the COVID-19 pandemic, which delayed trials and progress in proceedings, as well as by improvements in data registration in the company\u2019s new procedural monitoring system. We had no cases resulting in warnings and\/or fines, nor there were any cases of non-compliance with voluntary codes [GRI 416-2]. As part of an international initiative to improve patient safety and care quality, we held nine Zero Harm workshops (two in 2022), four of which in the state of Rio de Janeiro, two in S\u00e3o Paulo, one in Bahia, one in Pernambuco, and one in the Federal District. Annually, a survey is conducted to gauge the level of patient safety culture perception within Rede D\u2019Or, using a survey instrument from the Agency for Healthcare Research and Quality (AHRQ). The goal was to explore how knowledge and technology can support the hospitals\u2019 journey in this direction. In 2023, 48,560 professionals from 68 hospitals (both owned and managed) attended the events. As a result, 67% of participants rated patient safety in their units as excellent or very good.<\/p>\n\n\n\n

Implementing the four pillars of the quality program leads to a culture of high patient safety and the democratization of quality standards across our entire network. Thus, we have been constantly evolving our indicators. An example of this is the recognition in the Brazilian ICUs project by the Brazilian Intensive Care Medicine Association (Amib, in Portuguese), which awarded intensive care units across the country with the Top Performer ICU and Efficient ICU certifications, indicating that the units achieved high or good performance, respectively, in the year. In 2023, 707 Brazilian hospitals participated in this project, 58 (8%) of which from Rede D\u2019Or; and 1,980 ICUs, of which 195 (9.85%) are part of our Company. Among the 234 ICUs recognized as Top Performers, 78 (33%) belong to Rede D\u2019Or, meaning that one in every three ICUs awarded with such distinction belong to us.<\/p>\n\n\n\n

Regarding Technical Quality, we have identified continuous improvement of quality standards as the main challenge, coupled with the expansion of activities and the growth of our network size, absorbing more hospitals. Another challenge, common to most healthcare organizations, is the shortage of specialized workforce. In this regard, we seek to mitigate the issue through professional training at IDOR. Learn more in Instituto IDOR. Finally, we still face the challenge of demonstrating to society the value of this new culture of quality, based on adherence to standards and protocols, and how it positively impacts patient care [GRI 3-3].<\/p>\n\n\n\n

Learn more at IDOR Institute<\/a><\/p>\n<\/div><\/div>\n\n\n

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Excellence in quality<\/h3>\n\n\n\n

GRI 3-3<\/p>\n\n\n\n

To provide a safer environment for our patients\u2019 treatment and the best possible outcomes according to each case profile, we maintain a structured Patient Quality and Safety Program based on the clinical governance pillars, as shown in the figure below:<\/p>\n<\/div><\/div>\n\n\n\n

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Technical Quality<\/h2>\n\n\n\n
\"Rede<\/figure><\/div>\n\n\n
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Performance Improvement<\/strong><\/p>\n<\/div><\/div>\n\n\n\n

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Process management<\/p>\n\n\n\n

IQT Management<\/p>\n\n\n\n

Accuracy of indicators<\/p>\n\n\n\n

Variable compensation<\/p>\n\n\n\n

Improvement cycles<\/p>\n\n\n\n

Technical visits and Practice Manual<\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n

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Quality Management<\/strong><\/p>\n<\/div><\/div>\n\n\n\n

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Document management<\/p>\n\n\n\n

Assistance practices<\/p>\n\n\n\n

Professional development<\/p>\n\n\n\n

Events and campaigns<\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n

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External<\/strong>
Drivers<\/strong><\/p>\n<\/div><\/div>\n\n\n\n

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Certifications<\/p>\n\n\n\n

ANAHP\/EPIMED interface<\/p>\n\n\n\n

Assessment of patient safety practices - Anvisa<\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n

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Patient <\/strong>
Safety<\/strong><\/p>\n<\/div><\/div>\n\n\n\n

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Risk management<\/p>\n\n\n\n

Event notification<\/p>\n\n\n\n

Perception, culture and safety research<\/p>\n\n\n\n

Patient experience<\/p>\n\n\n\n

Clinical audits<\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n<\/div><\/div><\/div><\/div>\n\n<\/div><\/div>\n\n\n

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Robust clinical and safety protocols<\/strong><\/p>\n<\/div><\/div>\n\n\n\n

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PROTOCOLS<\/div><\/div>\n\n\n\n

drawn up by in-house experts<\/p>\n<\/div><\/div>\n\n\n\n

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PUBLISHED
PROTOCOLS<\/div><\/div>\n\n\n\n

and available for all our hospitals<\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n

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Quality management<\/h3>\n\n\n\n

Our care practices undergo continuous evaluation through technical visits to the units and audits. The results are shared every month at Best Practices Meetings. To improve the units\u2019 processes and, consequently, improve each one and the entire Company\u2019s performance, we also conduct benchmarking visits among units to share information and experiences.<\/p>\n\n\n\n

To enhance the technical skills of professionals working in quality offices, we rely on a Quality Assessor Development Program. Since the beginning of the project, in 2021, we have had the participation of 53 professionals in Corporate Quality Technical Visits, which are conducted in-person, hybrid, or remotely. By fulfilling defined requirements for professional participation, assessors progress through categories: trainee, junior, mid-level, and senior [GRI 3-3].<\/p>\n\n\n\n

By the end of the 2023 technical visit schedule, the team was comprised of five senior assessors, eight mid-level assessors, eight junior assessors, and 22 trainee assessors. Since last year, we have enhanced the team through multiprofessional participation, incorporating into the group eight specialists in the following areas: anesthesia, hospital infection control, nutrition, pharmacy, and clinical staff management. In 2023, we welcomed four more specialists in the hospital infection control, pharmacy, and transplantation areas.<\/p>\n\n\n\n

Another notable initiative in 2023 was the Quality Workshop for professionals from the offices of 52 hospitals (27 in S\u00e3o Paulo\/SP, 22 in Rio de Janeiro\/RJ, and four in Recife\/PE), focusing on Process Management and Quality Tools.<\/p>\n\n\n\n

Our range of clinical and safety protocols is robust and widespread. Currently, we have 73 of these protocols prepared by Rede D\u2019Or specialists, 71 of which have already been published and made available to all hospitals.<\/p>\n\n\n\n

There seems to be a consensus that if certain procedures used in aviation training, such as mandatory simulation-based l earning, standardized protocols, checklists, and crew instructions, were transferred to the healthcare sector, the result would not only be a significant improvement in patient care but also a sharp drop in mortality rates. Therefore, in 2023, we initiated a partnership with an aviation pilot to discuss Crew Resource Management to minimize the chances of an accident caused by human error. Three courses have already been conducted with the key leadership of S\u00e3o Luiz S\u00e3o Caetano, S\u00e3o Luiz An\u00e1lia Franco, Niter\u00f3i D\u2019Or, Memorial S\u00e3o Jos\u00e9, and Esperan\u00e7a Olinda hospitals.<\/p>\n<\/div><\/div>\n\n<\/div><\/div>\n\n\n

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Performance improvement<\/h3>\n\n\n\n

GRI 3-3<\/p>\n\n\n\n

We anchor Rede D\u2019Or\u2019s management in processes where each business unit (emergency, ICU, inpatient unit, operating room, among others) defines the customers chain, suppliers, upcoming tasks, possible dangers, risks, and barriers, as well as process monitoring indicators. We have a 50 technical quality indicators panel, 24 indicators for adult patients, and 26 indicators for the maternal-child line, which we monitor in our hospitals, allowing for the analysis of hospitalized patients process and the outcomes.<\/p>\n\n\n\n

We publicly disclose the seven most important indicators, which are mortality, ventilator-associated pneumonia, average length of stay in adult ICU, ICU readmission rate, primary bloodstream infection (associated with deep vein use), urinary tract infection (associated with tube use), and pressure injury. All results are analyzed so that we can continue to improve our processes. It is worth noting that we have stood out in the Anahp rankings; under the Top Performer ICU seal, awarded by Amib and Epimed Solutions; and by the group of hospitals accredited by the JCI methodology.<\/p>\n\n\n\n

The indicators are also subject to internal audits to assess data accuracy. In 2024, we expect to implement an external assessment process conducted by independent entities. Analyzing the results of Rede D\u2019Or\u2019s Technical Quality Indicators (TQI) in 2023, we observe the evolution of our outcomes, with a reduction of 4.16% in the average length of stay in adult ICU, 11.11% in standardized mortality rate, 24.10% in primary bloodstream infection incidence density, 10.61% in catheter-associated urinary tract infection incidence density, 41.36% in ventilator-associated pneumonia incidence density, and 38.46% in pressure injury incidence density compared to 2022.<\/p>\n\n\n\n

It is important to note that, between 2019 and 2023, we recorded a substantial increase in the number of hospitals participating in Quali D\u2019Or Indicators adult profile (76%, from 37 to 65\u00b9), which also elevates the challenge of adopting practices in the new units to ensure the Rede D\u2019Or standard. Maintaining results at these levels, despite the integration of so many new units, is notable especially when compared to external benchmarks, demonstrating the importance of the Technical Quality pillar for our Company.<\/p>\n\n\n\n

Success stories are documented in Rede D\u2019Or\u2019s Manual of Care Practices, prepared with the collaboration of specialized professionals from hospitals across Brazil. In 2023, we implemented the second edition of the material in 69 hospital units, covering good practices in quality and safety and compliance requirements with legislation.<\/p>\n\n\n\n

A standardization manual is an important tool for internal assessment of our hospitals\u2019 performance, contributing to performance improvement and preparing for accreditation processes. Hospitals that achieve an overall compliance rate equal to or greater than 75% are recognized. Technical assessment cycles of the standards outlined in the Manual of Care Practices occur every two years. Hospitals that achieve an overall compliance rate equal to or greater than 75% are recognized. In 2023, the five best performing units were Hospital S\u00e3o Luiz S\u00e3o Caetano, Hospital S\u00e3o Luiz An\u00e1lia Franco, Hospital Vila Nova Star, Hospital Assun\u00e7\u00e3o, and Hospital S\u00e3o Luiz Morumbi. In 2024, the third edition of Rede D\u2019Or\u2019s Manual of Care Practices will be adopted following a revision process. Units are required to adhere to these standards to prepare for the assessment scheduled for 2025 [GRI 3-3].<\/p>\n\n\n\n

1<\/sup>Considering owned and managed hospitals.<\/p>\n<\/div><\/div>\n\n<\/div><\/div>\n\n

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It is worth considering that, between 2019 and 2023, there was a significant increase in the number of hospitals participating in the Quali D\u2019Or Indicators adult profile (76%<\/strong>, from 37 to 65\u00b9<\/strong>).<\/p>\n<\/div><\/div>\n\n<\/div><\/div>\n\n

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We have a panel of<\/p>\n\n\n\n

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TECHNICAL QUALITY INDICATORS<\/div><\/div>\n<\/div><\/div>\n\n\n\n
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INDICATORS FOR ADULT PATIENTS<\/div><\/div>\n<\/div><\/div>\n\n\n\n
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INDICATORS FOR THE MOTHER AND CHILD LINE<\/div><\/div>\n<\/div><\/div>\n\n<\/div><\/div>\n\n\n
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Technical quality indicators\u00b9<\/strong><\/p>\n\n\n\n

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\n Technical quality indicators (TQI)\u00b9 <\/th>\n \n 2023\u00b2 <\/th>\n \n 2022 <\/th>\n \n 2021 <\/th>\n <\/tr>\n
\n Average length of stay in adult ICU (days) <\/td>\n \n 5.07 <\/td>\n \n 5.29 <\/td>\n \n 6.29 <\/td>\n <\/tr>\n
\n Incidence density of ventilator-associated pneumonia in adult ICU \u2013 VAP (per thousand) <\/td>\n \n 1.12 <\/td>\n \n 1.91 <\/td>\n \n 2.92 <\/td>\n <\/tr>\n
\n Incidence density of central line-associated primary bloodstream infection in Adult ICU \u2013 BSI (per thousand) <\/td>\n \n 0.63 <\/td>\n \n 0.83 <\/td>\n \n 1.56 <\/td>\n <\/tr>\n
\n Incidence density of indwelling bladder catheter-associated urinary tract infection in Adult ICU \u2013 UTI (per thousand) <\/td>\n \n 0.59 <\/td>\n \n 0.66 <\/td>\n \n 0.73 <\/td>\n <\/tr>\n
\n Pressure injury incidence density in adult patients (per thousand) <\/td>\n \n 0.23 <\/td>\n \n 0.39 <\/td>\n \n 0.64 <\/td>\n <\/tr>\n
\n Readmission rate in closed units up to 24 hours (adult ICU) (%) <\/td>\n \n 0.28 <\/td>\n \n 0.34 <\/td>\n \n 0.33 <\/td>\n <\/tr>\n
\n Standardized in-hospital mortality rate (adult ICU) <\/td>\n \n 0.40 <\/td>\n \n 0.45 <\/td>\n \n 0.68 <\/td>\n <\/tr>\n <\/table>\n<\/div>