Estrategia de Atención Centrada en el paciente y su familia Experencia Colombiana Expositora

Good afternoon. Thank you so much for the invitation. I'm very happy to be visiting this beautiful city. I'd never been to Lima before; this is my first time in Peru. Thank you so much. It's a pleasure and a joy for us to be able to come and tell you a little about our

experience at the Cardioinfantil Foundation, in an area I led for over 10 years: the Patient Experience Department. This year, I'm taking on a new challenge, which is the Commercial Liaison Management. We aim to ensure that everything built within the organization, or the foundation, is truly implemented in the services and aligned with the insurance companies, starting from the initial contracting with service providers and

insurers. It's a new challenge I'm starting this year. So, God willing, I'll be sharing more updates on our progress in due course. Thank you again. Hospitals and healthcare organizations are always exploring the concept of humanization, which we also define as patient- and family-centered care. It's a topic that concerns and fascinates some of us. With all due respect to

the doctors, it's a topic that sometimes seems difficult to grasp, especially regarding care cycles that are so short or so long. And when administrators see so much detail, it becomes a bit overwhelming in managing families. Before defining what the patient experience or patient-centered care is, I want to tell you a little bit about where these

service concepts come from. How do organizations and the economy begin to speak? This graphic summarizes it quickly. When the economy began to evolve, everything was centered on agriculture. Then there was a decade where the economy was focused on the Industrial Revolution, then manufacturing, and solely on competition for quality. That's where the concept of product quality emerged, which

began to make a difference. Up until then, all organizations were in the same service groups. Then, in the 1990s, when product quality was so good, another fundamental and competitive element began to develop: service quality. All those added benefits where people's needs began to be addressed. As the user begins to choose organizations, and

healthcare organizations also begin to see the change, the focus of companies shifts, and all healthcare companies begin to become part of the broader service sector. One begins to see that service organizations start to view their users or clients as having completely different needs and expectations, and this presents a challenge—a competitive challenge. Up to this point, all the service courses

and topics one begins to see in the sector are largely copied from healthcare companies. We then begin to see that the discourses within the airline sector are easily copied from the healthcare sector, without recognizing that there are fundamental, necessary, and priority elements. It is then that organizations begin to work with these basic concepts, which are

fundamental and provide the structure for everything related to service. An expert, whose books are still available and which we all read, is Carl Brench, an American who speaks extensively about service, and thanks to him, the first models began to be developed and established. of service where the customer begins to form a vital part

in each of the organizations and where the concordance and coherence of everything— strategies, strategic framework, direction, systems, support tools, and people—must be around them. Human talent is fundamental in all of this development. When we begin with all the challenges that these times bring, the accreditations, the national ones, which the doctor already showed you in the

presentation at the Nariño Departmental University Hospital, how accreditation tools are fundamental to begin to look at patients and systems from that perspective. It is a much more specific approach that allows us to ground what is sometimes so difficult for us: explaining to the healthcare teams the service, the warmth in the humanized service, making that

tangible, how it is done, and it is done through many of the tools that the doctor already showed us. But if we want to define what a patient experience is, we begin to look at some topics in the literature. For example, here in 2009, in some surveys led by the GALUP Management Journal, they

interviewed many hospital directors and where they identified that the Patient experience: 34% answered that it is patient-centered care, 29% said it is a series of orchestrated activities significantly adapted to each patient, and 23% said it is providing excellent service to the user, the patient, or the client. This is where we come in. Let's look at and refine

the concept of humanization a little more. Let's look at one of the studies done by the Beril Institute, where they began working and managed to arrive at a very close approximation of what humanization is, what patient-centered care is, and what the patient experience is. They say it is the sum of all interactions

shaped by culture. Notice that each organization has a culture so different from the others, which influences the perception of what the patient experiences throughout their care cycle. And then below, they define each fundamental aspect of this concept, and that is the cycle, the journey that our patients and their families have throughout their

care and at every moment in the institutions. Here we can ask ourselves a question: Are healthcare institutions... Prepared not only to provide care but also to identify the needs of patients and their families. Sometimes we assume the patient comes alone, but that's not the case. The patient is a group of people who

benefit from or are affected by the illness or disability they suffer. They are at home with us, suffering, being encouraged, or affected by social circumstances. We are only addressing the pathologies themselves. This is where all the accreditation tools help us articulate these concepts. For example, at the foundation, we have identified nine basic needs

that must be checked and monitored from the moment the patient enters. These nine needs are fundamental because whenever a patient is in a vulnerable state, by identifying these needs we can provide support and assistance to the families, making their experience at the institution much more welcoming. This is documented in the admissions policy

for international accreditation standards, which covers everything related to access, to the extent that we are able to identify these needs. In terms of access, we are managing to have a positive impact throughout the care cycle. What are organizations seeking with humanized care? We have identified three immense things: one is the clinical component, ensuring that

communication, access, coordination, and discharge are aligned with all the attributes of quality, timeliness, safety, and others in the physical aspect. Then there is the ability to provide a healing environment encompassing everything from nutrition and the environment to interactions. And there is a large, fundamental emotional component: all the human connection, communication, spiritual support, and

sensitivity to identifying needs. What we seek with this is efficiency, achieving empathy with the patient and the medical or care teams so that the patient has a healing experience. Organizations are also now seeking to build user loyalty. You know, or perhaps you are aware, that the social security system in Colombia has additional

complementary plans where patients pay for extra insurance, which in some cases are policies or prepaid medications. This gives them the option of accessing some private clinics where the facilities, equipment, and technology are excellent, and the opportunity also offers many advantages. Then the patient begins to choose which organization they want to receive medical treatment from, where they want to go,

and this new exercise in the entire health sector economy begins to move very actively, delivering the Plus. What are the Plus benefits we're going to give our patients so they always choose us? We seek to build loyalty. At the foundation, we've defined seven fundamental pillars that are closely linked to what we're seeing in

terms of service offerings. When you look at the organization and identify that we can't develop short or long cycles of care, regardless of the patient's pathology, if we don't consider these seven transformative service pillars, as we've defined them, it's fundamental. Human talent, the training that is developed, achieving the development of competencies, achieving the

identification of the users who are attending to patients, so that they can identify their patient and see them as a person with many needs that can be addressed and met at any given time, developing that ethos and that sense of service that people must have, especially when they are face-to-face with the user. Process redesign—I don't know if this happens

here in Peru, but here in Colombia, we sometimes have institutions where processes are designed for the organization and to shield, let's say, all the administrative and billing issues. We really need to turn those processes around. They should be designed to allow patients and their families access to technological tools. We live in a world and a time where

technology should bring patients closer to organizations, not distance them, avoiding red tape and unnecessary travel. And that's what we're looking for: better communication tools with patients and their families. The goal is to ensure that medical treatment, the opportunity to choose and decide, is facilitated through communication tailored to the patient's nature and cognitive abilities. The

service offering is about why we open the doors of healthcare organizations. What are hospitals and emergency services for? And that's closely linked to all the issues of opportunity. We have patients entering clinics and there's no opportunity for specialist care or no beds available in the network. So, the strategies are aimed at improving things a bit. Everything related to the

service offering, infrastructure, and welcoming, warm physical environments that allow the patient to identify with a much more pleasant space, not those cold and gloomy spaces that some hospitals end up being. And the after-sales service—this is something we invented, and it's simply about helping the user move very quickly from one service state, whether it's emergency care or

hospitalization, and be able to immediately access the next service, whether outpatient or surgical, without so much hassle and administrative paperwork. These are the transformative pillars. What we seek is for the experience of the patient and their family to truly be different at the Cardioinfantil Foundation. And we also seek to continue guaranteeing and

maintaining the social programs that I will tell you about later. I started the presentation backwards, telling you a little about what the concept of a patient and family experience is, or the concept of humanization, and now I'll present what the Cardioinfantil Foundation is. We need to measure what is done in every way. And with these

components, we achieve this through the satisfaction evaluation program. We apply surveys at different stages of patient care. These are the five variables or components by which we measure services or care cycles. The survey scores focus on these issues. They also align with national accreditation standards and some international ones. These standards are based

on the humanization policy, which encompasses attitude and warmth in care, communication, and very important quality attributes such as privacy, timeliness, and a welcoming environment. These are just some of the tools that allow us to identify this aspect or component of humanization. We have a policy that structures and under which all the programs we use to support

patients throughout all care cycles operate. I'll explain how they work. We have a policy of duties and rights that, if used as an effective tool, allows staff and collaborators to understand and recognize their rights and know how to care for patients, preventing violations of those rights. They will identify these rights in their

important, simple, or complex activities and learn how to ensure they are respected. To ensure that patients' rights are not violated and are respected, we have a pain management policy with a comprehensive program for identifying pain scales or levels, providing support to the patient and their family throughout the final phase of life. We also have

admissions and discharge policies that identify all the needs. These are some of the programs that allow us to strengthen patient- and family-centered care, from which all the programs we have in the institution are developed. We offer spiritual support and accompaniment, strengthening the culture of service, support for the patient and family through coordination rounds, managing silence,

handling complaints, evaluating satisfaction, and procedures for the safekeeping of belongings, as well as the program of duties and rights. We begin... Sometimes talking about service in healthcare organizations is n't so easy, and it's an issue that also arises when heads of administrative and clinical services send their staff, and they don't go, the

coordinators don't go, the heads don't go, and they end up going The people who are face-to-face with the user and on the front lines—this was the program, and this is the program as we have it structured. We created a service protocol for people entering the institution. We have to tell them how we need them to be received, and how

we want them to receive our patients. What are the scripts? What are the expected attitudes? Because the corporate image is important, because a uniform is provided, because it has to be impeccable. Because communication has to be successful, because we have to be discreet with the information. All of this is taught in the service course; it's part of

the strengthening program. We take the opportunity to present the duties and rights there. The duties and rights are evaluated using forms, and we are doing a whole exercise with the staff. We started receiving questions from staff in 2010, and in 2009 we started receiving them. Why is n't my boss here? Why doesn't my boss

follow the rules? Why is he the most indiscreet? Why does he ask me to let a recommended person go ahead of everyone in line and violate the rights of those waiting? Why is my boss? Why is my boss... So this program was developed with human resources management, and that's when we invited Ana Lucía to

come as an expert and explain to the directors and heads of services— from a consultant's perspective—what service is. So before starting with the topic of humanization, we began by talking about service protocol, image, and etiquette. There's a very beautiful concept here, which is that you have to work on being for being. Nobody provides service

if they aren't capable of living and feeling it. And that's fundamental: choosing and reviewing the people who are on the front lines attending to our patients because nobody—nobody, really—is capable of providing service when they don't feel it, don't receive it, and don't experience it. These are patterns. From the foundation, with Ana Lucía,

we developed about seven modules and began to raise awareness among the area heads. Currently, the service course is part of the performance evaluation for signing an indefinite-term contract. People who are new to the foundation have to go through the service course and are evaluated. If they don't, well, it's one of the requirements for

signing a contract once they pass the probationary period. This is another of the programs we offer. The lifeline. Sorry, regarding the entire service culture strengthening program, we always have to be with our employees, training them on different topics: stress management, etiquette, good manners. In Colombia, we have a policy of not using the informal "tú" form.

There are basic and simple things that facilitate communication, and there are others that create barriers to communicating respectfully with users. So, no, "Grandpa," no, Grandma," call them by their name. And you know, when you start to look at—we are already internationally accredited—when you start to look at the standards of the joint, you

begin to identify that one of the fundamental elements is: you call the patient by their name. So, we have to start creating these cultures of validating the other person, of respect, of understanding that they are not a number, not a bed, not a body, not an organ, not a pathology; they are an

identified individual with a name. This is a quick overview of how we have been developing the service culture strengthening program. We already have in- service trainers who are the same employees; we train them, and they have some skills to do... They are certified and teach the service workshop outside of regular hours, and they are

paid for the 4 hours. They also administer exams and submit evaluations. So it's additional work they do. There's also the corporate image workshop; we teach the girls how to apply makeup so they don't look so pale, especially those on the front lines, and how to keep their nails neat and clean. We also teach them about uniform management

and all the service-related topics. Here are some photos. We looked for consultants. Ana Lucía has also helped us a lot with image, both for managers and directors. People need to be taught how to apply makeup if the uniform is corporate. They use blue and red colors. What makeup should we wear? So, that's the exercise we've been

doing. This is the line, the format that evaluates the service protocol. There's another workshop we give: disability management. How are patients with disabilities identified? And we look at the four elements: physical, visual, auditory, and cognitive disability. It's an experiential workshop where staff, orderlies, security personnel, nursing assistants learn. And everyone in hospital engineering identifies and we learn, and

have learned, how to identify hospitals that are not accessible, the bathroom, for example, for wheelchair access, how difficult it is with the elderly or with children. And it's to help us plan and design new areas that are remodeled with technical standards for patients with disabilities. Another topic we work on in patient experience or

humanization is the accompaniment through coordinators. They are in the emergency room, in hospitalization, and at discharge. So we are identifying the needs of patients who arrive, who are already in the institution, or who are leaving. And these coordinators make rounds. These are the figures: How many We are impacting patients monthly and annually, and they make rounds

accompanying families to help close gaps in communication or opportunity. We conduct a satisfaction evaluation, and these are the attributes where the patient rates the service at the institution very highly. We still have many opportunities for improvement. We have the complaints program that allows us to identify what is happening in the areas, what is recurring. The

complaints tool is an invaluable tool for humanization because it is also free. We don't pay anyone to tell us what we are doing wrong, but they do take advantage of it. And it's a topic that the heads of services don't like; not everyone fights because complaints are filed against them. But look at complaints as that

valuable work opportunity to see what is happening within the institution and what we can improve. We quickly classify the complaints into two categories: complaints due to process deficiencies, where once the head of service and their collaborators analyze the complaints, they identify that we made a mistake, that the process, the protocol, and the

procedure indicate one thing, and the collaborators carried out another. In other words, there was an error, and those complaints... They are answered in the tool, and the manager has to attach an improvement plan. Sometimes they also attach supporting documents, complaints, warnings, sanctions, and so on. There is another group of complaints where we fail to

meet the patient's needs, we don't meet their expectations, and yes, as the saying goes, it's not our fault. There are clinics that offer other services, other amenities, other hospitality that we can't fulfill. These complaints are welcome; when there's time and we manage to overcome the deficit issues, we have to start working on them, and they are

good ideas for implementing new things in the institutions. But for now, the managers can rest easy; these are complaints that are classified as dissatisfaction. They don't generate improvement plans for now because the institutions' protocols already say something else. These are just tools we use for dissemination to people regarding humanization. We have to keep telling people in the

institution what we are doing, what services are going well, regarding the issue of silence and privacy. This is a service bulletin where we share and publish the different topics we are developing in pediatrics. There is a topic of virtual classrooms where students are being educated. All the children who can't go to school because they have pathologies, or are

excluded from schools because they are in the transplant period, or because they ca n't be in the community, or because their medical treatment in the hospital is prolonged—so the teachers go to the school, to the foundation. Here we have some images of the teachers accompanying us. The Secretary of Education accompanies us, it

's certified, and the first images are of the grades of the children who manage to be in school. No matter the illness or pathology they have, we must fulfill children's duties, children's international duties. Here are some photos of how we make the topic of children's international rights or rights more accessible. Another exercise we have strongly emphasized is that we

work with Resolution 13437, which is part of Law 100 of 1991, which addresses patients' rights. What we did in 2009 was modify it. It's also part of the improvement actions that the accreditations left us with, and we need them to include five new rights: the right to pain management, the right to education, the right to

a second [right/right/etc.]. In our opinion, the right to report complaints and the right to privacy are five new rights that accreditation processes are bringing to healthcare organizations. We conducted a thorough verification using the methodology suggested by the Association of Clinics and Hospitals, and that's how we amended our declaration of rights. So now

we have five new rights. Some are part of the basic rights outlined in the standard's resolution, such as respect. Under respect, we included all the rights related to complaints and privacy. The right to pain, since none of the resolution already covered it, we left it as is the right to education. So now we have these five

rights in our declaration. There's an exercise that's always strongly encouraged, and that's how patients' rights are being presented. As you saw, we presented them in workshops and programs, we published them, we conducted exercises on social media, we held competitions for staff, we played games, and they participated with stories, pieces, and performances. Look, the doctors in the

pediatric ICU invented this story called "It's a Little Bear." This is our teddy bear from the social program. When children with heart conditions undergo surgery, they receive it as a gift through volunteer work. They donate these teddy bears, which are therapeutic because he needs chest support during his recovery. So they use the teddy bear. This is the

transplant unit. They made a story, Snow White and her poor little liver. It's just to tell you that sometimes when accreditations start asking for strategies on duties and rights, we do so much that one says, " What more can we do? What more can we do?" And we all have to show, all the time. So

there are doctors who make videos with groups of people. Because the idea is that we gave them a task: What is the right that you feel is difficult to fulfill in your area and for which you receive the most complaints? Choose a right and a duty. Then they started working on strategies for fulfilling that

right in non-invasive methods. What affects them is that the doctors and nurses are answering their cell phones, and they made a video. There are some doctors who are from the coast, and so they all made a video singing "The Bone," and it turns out that the bone is the cell phone. Answering the cell phone during

patient care or an exam is inappropriate. These are games our volunteer team plays when one starts developing topics of Humanization is beginning to be felt in the areas where we lack personnel, and sometimes in the teams of volunteer staff, who are people who can help us and are currently supporting us tremendously with issues

related to the patient and family. These are some images I'll quickly show you: our playroom is a themed playroom based on values. These are some images of the foundation; we have ecological terraces, the unit, remodeled units, and our challenges: we are designing new products from the marketing area with the goal that the

patient doesn't encounter barriers in accessing the next service, but rather that if they leave the specialized medical consultation, they can immediately access outpatient services, surgeries, or other procedures. We are running a campaign with insurance companies because they tend to authorize services in a fragmented way, and the patient ends up going all over the city

trying to complete the medical orders. So, the alliance here is to work with the insurance companies so they recognize that within the same building, under the same roof, we provide all the services, and that patients don't have to go on those marathons. It's simply to tell you that we develop everything from the methodology of projects and what we are

looking for is that these seven transformative Pillars facilitate access to care and discharge for the patient in all areas of the institution: emergency room, hospitalization, surgery, and specialist centers. Some strategies that have been efficient and effective are making immediate appointments. We are also identifying opportunities in some services and installed capacity. This allows us to do all this mapping, and

this year we are looking at these 10 components. We are already working on an exercise; this year we did the diagnosis of humanized care under the standards of Plain Tree. This is an organization in the United States, and there are already many certified organizations worldwide. In South America, only the Albert Einstein Hospital has this accreditation in

humanization. These 10 standards are developed. Some standards are not as well known in health institutions, such as number nine, for example, integrative therapies, paths to well-being. There are some that we have been working on, such as human interactions, and that is that we have to work from all aspects of human talent, and

then the patient and the family. The Albert Einstein Hospital in São Paulo, Brazil, already has its second gold designation. In the gold category, they manage bronze, silver, and gold, and the foundation, with everything we're doing, wants to merge all aspects of the care line and move towards a more humanized approach under these standards. This is our challenge.

Here I am telling you a little about our challenges. There's the image of Dr. Reinaldo Cabrera, founder of the organization, and now I want to represent my organization. This is the mission: our mission is to care for Colombian children with limited resources and cardiovascular problems. That's how the Cardioinfantil Foundation was born; that's why it's

called the Cardioinfantil Foundation. But it turns out that, as these children grew up and need medical attention throughout their life cycle, it's also called the Institute of Cardiology, and we care for all adult and pediatric patients throughout their life cycle and with all additional pathologies, not just cardiac ones. This is the vision: to

continue guaranteeing the fulfillment of the vision and the mission and to be recognized nationally and regionally for clinical excellence. Our strategy is to provide specialized care to children and adults nationally and regionally, focused on everything that... In the cardiovascular line, we have strategic objectives: patient experience and humanization. We develop the latter very strongly, which is to

excel in high-level, specialized, and highly complex medical care with a strong human touch. All patient experience programs are geared towards this strategic objective. We have six values: passion, honesty, commitment, excellence, ethics, solidarity, and warmth in care. Here are some images. This is the installed capacity of the foundation: we have 323 beds, 92 in the US in pediatric hospitalization,

204 in adults, and 27 suite beds; six intensive care units for 90 beds in adult, pediatric, and neonatal care; and in the emergency room, we have 30 beds. These are the diagnostic support lines and operating rooms. This is the human talent: on average, 492 doctors, 327 nurses, 492 nursing assistants, 192 other professionals, and

430 administrative staff. Some figures of our discharges and statistical data from the last three years ( 2012, 2013, and 2014). These are the medical teaching agreements we have with... Universities in 19 postgraduate programs, we are already a certified university institution, so student turnover is high, and the induction and training exercises with the students are also a

strong issue, we have managed it. Although student turnover is not easy in organizations with such specific programs for identifying patient needs, it always demands a lot of socialization and learning work. These are the international alliances with Cleland Clinic, with the Andrea Natale International Arrhythmia Center, and with the Mount Sina Medical Center Valenti Fuster. This is

our social program, we have two, the flagship one is "Give a Life," which is to identify children. Brigades go monthly to different departments. Alliances are made with radio stations and some regional hospitals so that the information reaches the most remote villages in the department of Colombia. The children arrive in buses with their mothers and

fathers. A whole two-day evaluation is done. Cardiologists go with portable equipment to do echocardiograms, and children with cardiac pathologies that have never been treated are identified and immediately placed in alliance. With Avianca, with whom we have an agreement, they transport the children with their mother or father to Bogotá. We have a foundation there where the children arrive

with their responsible adult, and all the outpatient care begins. They have surgery, and once they return, they go back to the shelter. They stay for eight days, for as long as the doctor deems necessary, and then they are discharged so they can travel to their city of origin. We make connections with regional hospitals

so that the regional doctors can manage their follow-up care. But we are always taking children out of the rural areas of Colombia, and it's incredible. We are rescuing children with heart conditions at a very young age, which was our founder's dream. "Eating with Joy" is a very beautiful program that also manages to find children

in the quarries, which are places in the mountains where they don't have good nutrition, where the child's development is below the appropriate percentiles. They enter the program, the mothers are educated on how to feed the children properly with very few resources, they are given cooking classes and activities, and these children receive all

the nutritional support once they are there. We managed to get them out of the program and more slots opened up for the next children. These are the two programs that manage these main points of the entire quality management system that the foundation is working on. This year we also ranked seventh in the

ranking of clinics and hospitals. It's a job where what we do is show all the development that takes place. Here are our founders, Dr. Reinaldo Cabrera and Dr. Camilo Cabrera. Reinaldo Cabrera was an adult cardiologist and Dr. Camilo Cabrera a cardiovascular surgeon. Here is the whole issue of the quality management system. The

institutions that are accredited with the Joint Commission are four in Colombia: the Cardio Infantil Foundation, the Santa Fe Foundation (this year), the Pablo Uribe Hospital (last year), and the Navarra Cardiovascular Foundation. So far, I came to tell you a little bit about what we've been doing. Administrative strategies are sometimes fundamental when we are all one

hospital. That's the message we wanted to bring you: the challenge is always great. We have never finished growing in this area; we are always exploring better practices to achieve... Families, to help them move forward, to be diligent with medical treatments, or simply to accompany them through the stages of grief—that is humanized care, and that is the

patient's experience. Thank you very much. [Applause] [Music] [Applause]