Desenvolvimento da cultura de

qualidade em uma grande corporação da indústria da Saúde.

Quem somos!

Americas Serviços MédicosCearáFortaleza• Hospital Monte Klinikum

Rio Grande do NorteNatal• Hospital Promater

PernambucoRecife• Hospital Santa Joana Recife

Rio de JaneiroRio de Janeiro - Capital• Hospital e Maternidade Santa Lúcia• Hospital Pró-Cardíaco• Hospital Samaritano – Botafogo

• Americas Medical City (Samaritano Barra e Vitória Barra

• Americas Centro de Oncologia Integrada

Distrito FederalBrasília• Hospital Alvorada da Brasília

São PauloSão Paulo - Capital• Hospital Samaritano Higienópolis• Hospital Vitória Anália Franco• Hospital Alvorada• Hospital e Maternidade Metropolitano• Hospital Paulistano• Hospital TotalCor• Lotten EyesMogi das Cruzes• Hospital IpirangaGuarulhos• Hospital Carlos Chagas

Caieiras• Hospital de Clínica

CaieirasArujá• Hospital e Maternidade

Ipiranga ArujáSantos• Hospital Vitória SantosCampinas• Hospital e Maternidade

Madre Theodora

2.781leitos

17.368 colaboradores

704 leitos de UTI

145 Salas cirúrgicas

126.762cirurgias/ano

220.258internações/ano

3.661.635exames/ano

2.097.764Atendimentos emPronto-socorro/ano

01Experiência do Paciente

04

Bem estar da equipe de cuidado

02Saúde da

população

03

Eficiência nos custos

Quality and Patient Safety Pillars(2018-2023)

Safety Culture Clinical Governance Patient ExperienceHigh Reliability

Organization

• Mutual Trust

• Clear communication

• Detection and reduction of risk

• Incident recovery

• Confidence in the measures

implemented

• Professional responsibility

• Fair culture

• Resilience

• Effectiveness of clinical

intervention

• Clinical audit

• Efficient risk management

• Education and training of

professionals

• Evidence-Based Practice

• Transparency in all processes

and interpersonal relationships

• Accountability

• Team Engagement

• Value in care

• Eliminate waste and care

uselessness

• Patient activation

• Clinical outcome

• Customer satisfaction

• Respect the patient's

preferences

• Full attention

• Sensitivity to operations

• Concern about failures

• Continuous improvement

• Reluctance to simplify

• Commitment to service delivery

• Empowering professionals

• Deference to expertise

• Resilience

• Perception of culture survey

• Data validation

• Clinical audit

• Accountability Matrix

• Definition of roles and

responsibilities

• Clinical audit

• Risk management

• Focus on the patient

• Professional development

• Patient involvement

• Evidence-based assistance

• NPS

• HCAHPS

• What matters to you

• Person

• Impressions

• Processes

• Local

• Definition of roles and

responsibilities

• "Zero Harm"

• Assessment of high leadership

• Learning from mistakes

• Proactive Assessment

• Crew Resource Management

• Previously designed processes

• Accountability

Tools Tools Tools Tools

1 morte/783 internações

National QPS (quarterly)

learning sessions

KPIs QPS in Friday Meeting (monthly)

Regional QPS (monthly)

Nursing managers / General wards / Operation rooms /Emergency Department / ICU/ NICU/

PICU/ Infection Control /Pharmacy Clinic /Patient Quality and Safety

Local QPS (monthly)

Incidents (including Infection control)

Care Risks

KPIs departments

Coverage and profiles of QPS

Main Achievements

All hospitals assessed

UHG Essential Standards

Created and structured at corporative level

QPS & Care Practice Teams

Adequacy to categorize Adverse Events

WHO Taxonomy

Published to guideQuality and Patient Safety in

healthcare practice

QPS Guidelines

Implemented in all hospitals 74.663 notifications by

Dec,18

Notification System

Established to manage critical events with permanent

harm/ death or institutional image risk.

Crisis Committee

Standardized, collected and reported to monitor and

compare

KPIs and QPS metrics

Established to evaluate cases treated by crisis committee

when necessary

2nd Opinion Committee

Dec, 18Jul, 17

Daily huddle focused in safety1.581 interventions

Success rate 83%

Safety Huddle

Hospital Accreditation

International Quality Program

Accredited Accredited diagnosis

National Quality Program

Accredited Accredited diagnosis

• Alvorada Moema• Paulistano• Samaritano Higienópolis• TotalCor• Pró-Cardíaco Botafogo• Samaritano Botafogo• Centro de Oncologia Integrado RJ• Santa Joana

• Vitória Analia Franco• Américas Medical City• Monte Klinikum• Alvorada Brasília

• Caieiras• Carlos Chagas• Ipiranga Mogi• Madre Theodora• Metropolitano Lapa• Santa Lucia• Alvorada Brasília

• Ipiranga Arujá• Santa Lucia

Resilience

Corporate supportCrisis Committee

Identificationrisks

• Care

• Image

• Legal

• Media

• Human Capital

InitialMitigation

Support

Disclousure • Validation

Root cause analysis

•Care•Image

•Legal•Media

•Human Capital

Corporate supportTechnical camera

Identificationrisks / Trigger

Specializedsupport

Care planvalidation

Second opinionor telemedicine

Example

•ED

•ICU

•Pediatric

•CoEs

FOCUS:

• Support specialists for conduct cases

• Protection of those involved

• Group learning

• Corporate Uniformity • Triple aim

Corporate supportSafety Huddle

FOCUS:

• Individual action: mitigation action / caresupport. Ex: Error in administration ofchemotherapy

• Action prevalence: corporate actions tosupport the process. Ex: suicidal ideation

IncidentsReport (24h)

•Average 300 incidents / day

Validation of critical

incidents

SafetyHuddle

Local Prioritization

•Average 20 incidents / day

• Support decision

• Support Regional QPS

Safety Huddle

344

252

158

362

465

12

11

3

9

19

0 100 200 300 400 500 600

NE - DF

RJ

Samaritano Higienópolis

SP 1

SP 2

Incidence of notification with intervention for resilience (AGO18-Jan19)

Interventions Deaths

Analysis of 2018 Severe Adverse Events

Total

Reported

759

NUMBER OF CASES

IN SAMPLE

Source: Sample from Notification System – EPIMED, 2018.

DISTRIBUTION BY SEVERITY (%)

NOTIFIER´S PROFESSIONAL

CATEGORY (%)

BRONCHOASPIRATION

ERRORS AND DELAYS IN MEDICAL CARE

INCIDENTS BY TYPE

12%

19%402

Incident analysis flow

Proactive analysis

Care team / Team patient safety

Londol ProtocolPrevalence analysis

Corporate support

Riskcircumsta

nceNear miss

Incidentnoneharm

MildHarm

Adverse Event

Adverse event

moderatedamage

Adverse eventsevere

damage

Death Crisis

Safety Huddle

83%

17%

Success in resilience level 2 Death

1581 interventions (Ago 18 – Jan19)

The Incident Decision Tree

2

1

The Incident Decision Tree

2

2

1 Sabotage, intended harm etc

2 Substance abuse without mitigation

3 Substance abuse with mitigation

4 Possible reckless violation

5 System-induced violation

6 Possible negligent error

7 Guiltless error but advice is needed

8 System-induced error

9 Blameless error

Obrigado!

Dario Fortes Ferreiradarferreira@americasmed.com.br