Case study - Hospital de Câncer de Barretos- FundaçãoPio XII - PDF

Case study - Hospital de Câncer de Barretos- FundaçãoPio XII Hospital do Amor (Hospital of Love) Av. Antenor Duarte Villela, 1331 Barretos - SP Phone:

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Case study - Hospital de Câncer de Barretos- FundaçãoPio XII Hospital do Amor (Hospital of Love) Av. Antenor Duarte Villela, 1331 Barretos - SP Phone: Introduction This case study describes the services provided and current funding structure of the Hospital de Câncer de Barretos (HCB), an internationally renowned oncology and research institute based in the countryside of the state of São Paulo, Brazil. The hospital serves 3,000 patients each day, coming from all regions of Brazil and suffering from all types and levels of cancer. City governments from different parts of Brazil organize transportation and sometimes rent houses for patients to undertake their treatment at the hospital. All the treatment, medicine, housing and food are provided to the patients for free. The following case study intends to look at the Hospital s structure, services, marketing ability and financial strategy and discuss alternative sources of funding and long-term financial stability. Prof. Dr. Edmundo Mauad Prof. Dr. Mauad is a medical graduate of the Faculty of Medicine of Campos County, Rio de Janeiro (1978). He then went on to complete an Internal Medicine and Gastroenterology residency. He subsequently completed Master of Science at the University of Bristol where he worked as a researcher in the Department of Medicine, Bristol Royal Infirmary Hospital. Prof. Dr. Mauad then went on to complete his PhD at Faculty of Medicine of the Federal University of São Paulo. He also has an MBA in International Health Administration from the São Paulo State Getúlio Vargas Foundation. Prof. Dr. Mauad is a member of the Board of Directors of Barretos Cancer Hospital since 1987, Chief of Cancer Prevention Department and Head Administrator of the Teaching and Research Institute. He has been directing programs of opportunistic and organized cancer screening of breast, cervical, prostate and skin since He has simultaneously studied different aspects of cancer prevention such as cost-effectiveness, community intervention, introduction of new technologies, role of information in assessing patients' adherence, educational programs for patients and professionals and strategies to improve quality of screening programs in underprivileged population in Brazil. Henrique Prata Mr. Prata is a landowner and livestock raiser in Barretos. His parents Paulo Prata and Scyla Prata were both doctors and founders of Hospital São Judas Tadeu, the hospital that founded the Hospital de Cancer de Barretos. Mr. Prata took over the management of the hospital in 1988 and continues to manage the hospital. Hospital Background In 1967 Dr. Paulo Prata noticed that cancer patients in the countryside of the state of São Paulo did not have access to cancer treatment. At the time the only public and specialized cancer hospital was A.C. Camargo in the capital. Barretos, 427km away from the capital, did not provide its citizens with cheap and easy transportation options to reach São Paulo. He founded the Hospital São Judas Tadeu in Barretos that offered treatment to patients in the region. Dr. Prata established a philosophy of equal access to care for all patients at the hospital. He treated privately and publicly insured patients the same way and preached humane medicine practices in his hospital. His humane practices meant treating all patients with kindness, politeness and respect irrespective of their background or condition. Dr. Prata initially financed deficits of the hospital with his own family wealth. In 1988, the hospital was in a bad financial conditions and Dr. Prata thought of shutting it down. His son, Henrique Prata, was able to raise money with fellow farmers of the region to pay the hospital debt and invest in new equipment and an expansion. Hospital de Cancer de Barretos (HCB) was then founded. Since 1988, Mr. Henrique Prata took over the management and has taken care of its operations and expansion. To help finance the hospital activities, Mr. Prata has developed a series of fundraising activities that complement the money paid by the Brazilian government for SUS 1 : concert with Brazilian celebrities, cattle auctions, tax breaks, individual private donations are a few examples (more details described below). In 1997 the Associação Voluntária de Combateao Câncer (AVCC- Voluntary Association to Combat Cancer) was founded. In 1998, the hospital arranged a concert with 3 of the most famous country duos in the country called AMIGOS (friends) in Barretos. The US$1 million generated in revenue from the concert was given to the Hospital. Starting in 2001, the hospital engages artists to record music albums and all sales revenues are channeled to the Hospital. With the help of funding from the Ministry of Health in 2002 three additional departments for Surgical Center, Intensive Care Unit and Interning Department were built. AVON and Brazilian artist Ivete Sangalo partnered to finance the construction of a 7,200 sq. mtr Prevention Institute in Sistema Único de Saúde (Unified Health System) is the Brazilian integral and universal public health insurance. All Brazilian population has access to treatment in any hospital that accepts this government insurance. It covers from medicines, primary, secondary cares to organ transplants. SUS was created in 1988 with the Brazilian Constitution. In 2000, the Ministry of Health of Brazil recognized HCB as the number one the country in Hospital Quality among the 6,530 public and private hospitals evaluated. In 2007 the Organização Nacional de Saúde (ONA- the national health organization) accredited the hospital with Level 1 Health Quality. The hospital has grown to attract the best oncologists in Brazil and has specialists in every practice. It has also started partnerships with laboratories, schools and pharmaceutical companies to develop oncology research, treatment techniques and training of specialists. Goals of the organization The 2009 report of activities of the hospital lists as main goals: a. Provide free medical and hospital assistance to all patients who need oncologic treatment; b. Promote research and studies in oncology, incrementing investigation and promotion; c. Promote cancer early detection and prevention; d. Create and maintain post-graduate studies and specialization on oncology; e. Contribute to solving medical and social issues, extending benefits to other public and private institutions. HCB seeks excellence in treatment by promoting humane care, constant professional and technical improvement and development and scientific outreach of education and research in oncology. The hospital also sees as their mission to strengthen and improve services financed by SUS. Governance The board of directors is composed of three directors from the Duarte Prata family: Scylla Duarte Prata (wife of the founder of Hospital São Judas Tadeu) as the President of the Administrative Board, Henrique Duarte Prata as Vice-President of the Administrative Board and his son Antenor Duarte Prata as the Secretary to the Administrative Board. Ms Scylla Duarte Prata is a gynecologist and is paid for her services as a doctor. Mr Henrique Duarte Prata and Antenor Duarte Prata do not work or earn wages from HCB, both are independent entrepreneurs. Following Dr. Prata s humanitarian philosophy that patients are the most important people in the hospital all doctors, nurses and technicians treat their patients with kindness and full attention. A very Interview with Dr. ValterPenna Prof. Dr. ValterPenna specialized in orthopedics during his residency at Hospital Matarazzo in São Paulo in He did his Doctorate studies in orthopedic surgery and orthopedics at the FreienUniversitat Berlin from 1981 to Prof. Dr. Penna worked at hospitals Albert Einstein, SirioLibanes and AC Camargo in São Paulo and in his private practice for 15 years before moving to Hospital de Câncer de Barretos. Since 2002, he has been the Chief of the Orthopedic Oncology Services at HCB. Prof. Dr. Penna explained that after working for many years in São Paulo in between hospitals and private practices, he saw the opportunity of dedicating himself to the practice of medicine in Barretos. He explained that although you make more money working in the capital, you work too much and do not have time to dedicate for research and professional development. HCB requests exclusivity from its doctors. That is, according to Prof. Dr. ValterPenna, the best opportunity for doctors to learn and become the best professionals in their specializations. He mentioned that the environment of HCB is very dynamic. Doctors have exposure to all different levels of cancers and complications due to the very high volume of patients. Surgeries vary from simple to the most complex possible and there are all the best possible resources to treat the patients, he explained. After his routine at the hospital, he has time to dedicate to research in the hospital laboratories and libraries. Prof. Dr. Penna mentions that there is a very good balance between clinic and research at HCB and the exposure to young resident students is stimulating. There is a sheer sense of cooperation and passion for medicine. At HCB I remembered why I decided to study medicine: to help people in need. There is nothing more rewarding than that, he finalized. active ombudsman office ensures this humanitarian treatment. The office has workers in every sector of the hospital to talk to patients and follow up on their suggestions and complaints (more information below) Vision Bring to Brazil the best practices in oncology treatment, research and hospital management seen around the world. Medical staff selects doctors to visit the best medicine schools in the world. Hospitals that have been visited by Dr. Mauad and his team include: MD Anderson Cancer Center (Barretos has academic partnership with the center) Memorial Sloan-Ketterling Mayo Clinic Johns Hopkins The Royal Marsden Institut de cancérologie Gustave Roussy Karolinska Institutet/Göteborg University Other hospitals in Berlin, Spain, Portugal and Japan have also been visited by Dr. Mauad s team. The goal is to learn not only techniques and scientific practices, but also learn about management and organization of other centers. HCB reflects the best practices doctors bring from around the world. Laboratories are set in the same way as the ones at MD Anderson, with which HCB has close scientific collaborations. All units are fully equipped, allowing full access and no competition between scientists. All technology and equipment are the best in the market. Dining, resting lounges and architecture of departments are inspired by European hospitals. Doctors, nurses and technicians relationships are as horizontal as possible - interaction is motivated in cafeterias, resting lounges and in meetings. Medical staff All senior doctors in the hospital are expected to have post-graduate degrees. Doctors that are approved for residency test in HCB, are motivated to conduct research and obtain degrees after they specialize. Doctors at the hospital have a technical vision, understanding and scientific engagement. HCB is the only Hospital in Brazil where doctors must have exclusive dedication (they cannot have a second job). Compensation varies according to experience, but not Human Resources Employees 1622 Paid Interns 15 Permanent Volunteers 190 Temporary Volunteers 15 Unpaid Interns 402 Consultants 80 practice. Doctors are motivated to collaborate and work in teams, in order to provide each other a more efficient working environment. Reward system for medical staff is translated into scientific and career opportunities. Doctors are motivated to go abroad for training and post-graduate studies, as well as developing their own research at the hospital. Patients that are directed to HCB are high complexity cancer patients. Doctors are exposed on a daily basis to complex and challenging cancer patients. The hospital has developed working collaborations through its partnerships with international hospitals. Almost on a daily basis, doctors have videoconference calls with international centers to discuss cases, techniques and treatments of complex patients. Doctors feel that the professional development in Barretos is far more rewarding than the financial remuneration opportunities. They also have a better lifestyle by not working many shifts. Hospitals in Sao Paulo pay better, but doctors work longer hours and have no time dedicated to scientific development. Doctors also mentioned that at HCB they feel the satisfaction of helping very poor patients. Ombudsman The ombudsman office is at the core of the hospital and its philanthropic nature. It was created in 2003, to learn and understand the needs of patients, companions, employees, service providers, volunteers and general public. The office managed by Ms Clarisse Duarte Prata, daughter of the founders, facilitates quality improvement and the detection of faults in the hospital and administrative processes. All employees work full time with the ombudsman office. The department has one assistant in each hospital department, who talks to patients and interacts with nurses and doctors. For example, if a patient is left alone for a period of time, these assistants will call the attention of responsible personnel; or if a patient seems unhappy with a diagnosis, the office directs the patient to another available professional for second opinion. Boxes are available through hospitals, where patients can submit their suggestions, complaints or compliments. According to HCB, the ombudsman office is not only a management tool for improvement but also a fast communication channel between the hospital and its beneficiaries. It provides guidelines to general management on deficiencies and irregularities. The department promotes hospital ethics and is guided by impartiality, legality and the National Policy on Humanization developed by the Ministry of Health 2. All requests and suggestions by patients are followed up with a letter. These letters are mostly either a follow up of the ombudsman office with the doctor involved in the case, the medical response or a conclusion of the process. Through this channel the hospital has reached over 80 percent approval rate from its beneficiaries. Structure 2 Policy created in 2003, requiring hospitals to value patients, doctors and other employees; provide autonomy to these individuals; increase co-responsibility of doctors and hospital management; establish solidarity and engagement channels on management; map interaction of participants; commitment with quality of services, among others. The hospital offers treatment and surgery for all cancer types. HCB sees and treats 3,000 patients every day. It receives patients from 1,210 cities in Brazil (data from 2009), from all states in the country. Unit 1 Size (sq. mtrs) 35,000 Number of beds 124 Intensive Care Unit Beds 20 Surgical Room 4 Surgeries per month 1350 Unit 2 Prolonged Palliative beds 40 General beds 22 The main hospital provides patients chemotherapy, radiology, radiotherapy, surgeries, examinations, biopsies and paediatric oncology. Hospital São Judas Tadeu has become a palliative center, receiving terminal patients offering housing, treatment, food and care. HCB has 1,000 beds for patients that come from out of town and need prolonged stay in Barretos with a family member. The hospital also offers housing for children and their parents for ongoing and palliative treatment. HCB offers inpatients services, with rooms for two patients and one companion each. The hospital receives over 850 inpatients a month. The intensive care unit has 20 individual beds with computerized parametric monitoring. Multidisciplinary teams of doctor, nurses and therapists attend to these sectors. Coverage Visits coveredby SUS 212,633 Visits coveredby private insurance 609 Private procedures 3 Total 213,245 The hospital also has an independent team of doctors and nurses specialized in infection control under international standards. HCB Microbiology Laboratory utilizes diagnostics techniques for infection control in all hospital departments. Full support is given to patients. There are full time physiotherapists, psychologists (for patients and family members) and a musicologist (specialist in using music as therapy). Volunteers also visit the hospital to engage patients in activities. Dr. Edmundo Mauad mentioned that some relatives staying at the hospital engage in volunteer work to raise money for the hospital, such as knitting clothing pieces for sale. However, overall companions dedicate full time to their sick relatives and are not required to engage in activities for the hospital. The hospital offers day-care facilities for employees children. It also offers resting places for bus drivers who bring patients from all around Brazil. Every day, buses and vans arrive in Barretos bringing patients from different cities around Brazil. These buses and vans are mostly financed by municipalities, to take citizens for visits, surgeries and other treatments. The drivers stay at the Drivers Lodge provided by the hospital. The hospital provides food to all guests at the facility. This service has as a goal to offer drivers rest and ensure that patients return home safely after treatment. Patients, family members and drivers receive free meals. Every month the hospital receives 40 tons of food donations, out of which 10 tons are meat and poultry produce. The Hospital has no expenses for food. Next to the main hospital, HCB has opened a Prevention Center that hosts laboratories for biomolecular and genetic oncology and other specialties. The Prevention center also hosts libraries, convention centers, video and photography labs, education strategy groups and early detection practices. Most Frequent Cases Females Males Breast 5,629 Prostate 8,015 Cervical 3,060 Lung 2,102 Lung 939 Stomach 1,813 Stomach 786 Esophagus 1,266 Colon 745 Larynx 924 Excluded skin cancer Patients who are treated and cured receive life-long support from the Hospital. They are followed up through the hospital system and invited for check-ups. (For more detailed patients data see APPENDIX I) Department of Diagnostic Imaging The department of Diagnostic Imaging of HCB performs 90,000 imaging exams and 4,000 imaging-guided procedures annually. It has the following equipments: - One 1.5 Tesla Magnetic Resonance Unit; - Two Helical Computed Tomography Scanners, one of which a multi-detector unit; - Four Ultrasound units with Doppler; - Four Mammography units, - One dedicated breast biopsy table - Four standard and two mobile radiography units - Two Computed Radiography units and a comprehensive PACS system, which integrates all the imaging modalities, with real-time image distribution to both hospitals. A team of ten radiologists and two sonographers diagnose and stage a wide variety of neoplasms. Nuclear Medicine Through secure, painless techniques and using radioactive elements this medical specialty performs exams (scintilography) and treatments. The exams performed at the hospital are: cerebral, myocardial perfusion, bone, renal (static and dynamic), thyroid and pulmonary scintigraphies. The Nuclear Medicine department has four beds regularized by the Comissão Nacional de Energia Nuclear (CNEN- National Commission for Nuclear Energy) for interning cases with iodine-therapy for treatment of thyroid tumors and other treatments. It also treats ambulatory patients with Samarium-153-EDTMP for palliative treatment of metastatic bone pain and iodinetherapy for benign thyroid illnesses. The Department of Nuclear Medicine has four doctors, out of which two are specialized in the area. It offers residency programs for medicine students and has achieved a Level III (maximum level) from the National Accreditation Organization (ONA). Clinical Pathology The Clinical Pathology Laboratory offers services in hematology, b
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