Read the Conversation
EF: 2020 was the year of diagnostics, 2021 the year of vaccines, what will 2022 be the year of?
OG: The year of consolidation of all scientific knowledge acquired during the past two years. In 2020 we had difficulties developing exams for diagnostics, in 2021 we gained great experience in developing treatments whilst the vaccine became a reality. In Brazil, we had great work in the diagnostic setting, Santa Paula is part of a big ecosystem called DASA, which represents 15 hospitals, 900 examination labs across the country, and integration of primary care. Santa Paula is not alone, and this was important during the pandemic because all the strategic procedures that we did were based on acquiring exams, personnel and exchanging experiences between hospitals. The greatest lesson from the pandemic was that we should work together. Due to Brazil being behind during the pandemic, we had time to talk to doctors in other countries, where the pandemic had already hit, to try and learn what was expected in terms of using ventilators, which treatments to try, and multicenter-scan studies. Collaboration was the word and people were of the most importance. The frontline people made all the difference.
Leading a hospital during the pandemic was the greatest exercise in leadership that I have had. I remember that in the beginning, the board of DASA said that I should not be on the frontline due to my importance, but I said that without my presence, my personnel would desert. This was before the vaccines and, with little information regarding the disease itself, we learned by doing and relied on courageous, dedicated, and professional people. It was a life lesson in terms of leadership and universal collaboration, therefore staying at the frontline and making the decisions was important. The situation changed every day, so another lesson was ultrafast adaptations to a new reality, and this reality was changing every day with new problems. Another lesson learned was using digital tools in the decision-making process. For example, telemedicine in Brazil was not accepted and we had to find ways to develop it in a fast and emergency fashion, this was pressure on the entire country. It allowed us to talk to patients through digital tools, access information regarding the severity of the disease, analyze the CT scan, and the decision process in admitting the patient. We learned the full scope of the usefulness of digitalization. This was a lifetime lesson, there is no coming back from the implementation of digitalization.
EF: If you were to design a Master in Pandemic Administration, what two courses would you make mandatory?
OG: Leadership and human relations. These were the two most important skills used during the pandemic and leading a healthcare facility. Understanding people and knowing how to lead, whilst being severe with requiring results and data, were integral factors. If we had a third course, I would say evidence-based medicine to base decisions on science and not politics.
EF: How do you see Santa Paula moving forward?
OG: Santa Paula was an institution fully dedicated to seeing patients. In the context of the hospital and DASA, I see research and teaching as the future but as part of a tripod: assistance, research, and teaching. I also see the incorporation of digital and the integration of patient care. We are developing technologies to assist in healthcare as we speak. I see artificial intelligence as a strong tool in helping hospitals and healthcare. For example, in the evaluation of a CT scan, the interpretation of the probabilities of a patient being admitted, and the algorithms detecting the gaps between patient tests to try and keep the patient coming back for care. It is expensive and ineffective to only treat with medicine, and so we need to work on prevention and prediction. We intend to work with lifetime care and not disease care whilst using digital platforms.
EF: In the context of Santa Paula meeting digital transformation, which two variables in the iron triangle would you pick to implement this transformation?
OG: Value is the first, we are working on value-based healthcare and have a department for delivering this. We want to know the value in what we are delivering in every step and not only knowing the outcome of a procedure. We want to go beyond a simple medical success and make a healthy contribution to the quality of life of the patient. Michael Porter discussed this fifteen years ago and, until now, we have been unable to enact this process due to financial constraints and limits on access to quality. Delivering care that makes a difference in the life of the patient is one of our priorities going into the future. Regarding cost, the best care is the cheapest care. Detecting a health issue early and enacting treatment early is a huge benefit for the patient in terms of value and cost.
EF: How did the hospital manage chronic disease within a communicable disease scenario?
OG: This is the biggest gap we had during the pandemic, the diagnosis, treatment, and control of chronic diseases. The number of patients that passed without an adequate diagnosis was enormous. Across the world, we are seeing the consequences of this. We are now trying to catch up with this gap and therefore detection is one of the key objectives of DASA. The Brazilian Heart Society has stated that the number of patients with uncontrolled heart failure and hypertension is enormous. The lesson is that chronic diseases did not disappear, and if we do not take care of them then they will reappear at a more intense level.
EF: How would you rate the level of adoption of digital transformation balanced with the human aspect?
OG: Santa Paula passed from a physical electronic record to an electronic medical record, and in 2020 we did the HIMSS Digital Certification achieving level 7, the highest level. We are now a paperless hospital and achieving this was difficult, but security threats, adverse events, and medical errors decreased significantly whilst also speeding the process. Digitalization made the hospital more secure. The electronic record has a vast number of pop-ups to ensure the procedure is done correctly. The balance between this transformation and the staff is to make sure that the technology is as simple as possible to free time for the nurse and the doctor to hold the patient’s hand. To be secure is a part of the value-based treatment and part of the care. Digital has also allowed us to dedicate more time to the interaction with the patient, we have been training staff in these areas whilst creating a patient office.
The patients see care in a very different way than the providers, quality goes beyond the results of procedures, and therefore we are investing in the patient-first philosophy. We also take care of staff personnel and collaborators, especially during the pandemic. We provided psychological support with tele-support and a high-level detection for burnout. The leaders created a strategic objective for how to take care of their staff. By the end of the year, the bonus depends on the Great Place to Work poll. Alongside the size of the financial and quality of care delivery, you must take care of your people. To deliver care, you must be well.
EF: Regarding this time of your career, what would you like to be remembered for?
OG: As the guy who was there for every moment and every minute. The best directors of hospitals are doctors, and this is because they were there and walked the talk. I did this and saw the difficulties inside the war, not from a distance. This helped to influence other doctors to do the same, especially older ones. I am a hands-on leader, and I would like to be remembered for this. There was a time when there was difficulty in organizing night shifts, and so we volunteered to come in at midnight every night for two weeks.
