Panel SA: Closing the Covid ICU was the event of the year, says Beneficência Portuguesa of São Paulo

Founded by Portuguese immigrants in the 19th century, the Beneficência Portuguesa Hospital of São Paulo lived, last week, another milestone in the hospital’s history: it closed the Covid ICU. For Denise Santos, president of BP, it was a significant event in the fight against the pandemic, which should leave legacies for the hospital business in Brazil, both from a technological and management point of view.

“I would like what was left of this pandemic to be this vision of cooperation. I have doubts if humanity managed to transpose this gaze. It is not possible to look only at your own institution and think that everything is right”, says the executive.

How does BP’s story begin? We are talking about 162 years ago, with Portuguese immigrants. This was very common. It has Italian colonies that also founded hospitals. We had the privilege of having the Ermírio de Moraes family at the head of BP for three generations. Some people even make a mess between the family, BP and Votorantim. In fact, they are separate entities, but it is a fact that the Ermírio de Moraes family has always dedicated an important social aspect to this country.

BP has several landmarks that match not only the history of medicine but also the city. We were the first hospital, back there, to have a CT scan, which came from the United States. At the time, nobody knew how to operate. We made the first acquisition of a diagnostic medicine company to make this service available.

In this historical look, is there any reference to another pandemic, the Spanish flu? What was it like to deal with the arrival of the coronavirus and how do the two compare? At first, it brings the feeling of insecurity, of fear. It’s no different in a hospital. We are ready all the time to take care of and treat, but when there is this surprise, of course it shakes. We have a view with a horizon of ten years. This concern for the long term traces a path in the complexity of medicine.

When the pandemic came, we anticipated some initiatives that were a little further ahead, but that did not change our long-term strategic planning, which is the construction of the health center. We talk a lot about the four Ps of medicine: prevention, prediction, personalization and participation, which I think is the most difficult, which is how we all participate in our health care. And the pandemic brought it up. We had been discussing this, how to engage the individual in their health. I think this will set the tone for the business in the future.

On the other hand, regarding the crisis itself, we do ten to fifteen crisis simulations per year. From simulation for the case of a fire in the neighborhood, to cyber attacks. This alertness helped. In December 2019, already hearing the news from China, we established a crisis committee.

In January, all of our statutory, board and committee meetings were virtual. Everyone who had an international vacation trip in January was quarantined when they returned. When the first case arrived, in March, it had a change of flow in the hospital, separating Covid’s ward.

We transformed some services, migrated to digital, attendance, telemedicine, exam drive thru. At the same time that we take care of those who needed it, we have the group that never stopped.
Most collaborators using public transport and dealing with uncertainty. After the vaccination, we had no hospitalized employees. But over the past year, there were several inmates. We implement support programs for employees and doctors, we extend them to family members, with psychological, physical and financial support.

Our large nursing audience is women. So, we supported these mothers to leave their children with someone, because the schools closed. Then came the second wave, which I would even say, for us in health, was psychologically worse.

I would like what is left of this pandemic is this vision of cooperation. I doubt if humanity managed to transpose this gaze. You can’t just look at your own institution and think it’s all right.

At that critical moment, the owner of the Cristália laboratory, Ogari Pacheco, manufacturer of one of the missing intubation supplies, said that some hospitals stocked up on the product, leaving other hospitals short. Had it? No way. I can speak for BP. I personally talked to everyone in the industry. We did a task force between several hospitals via Anahp [associação dos hospitais privados] to achieve direct import from India and China.

Chloroquine was a subject that took on large proportions. How was it to handle it? Again, I can speak for BP. All treatments, not just Covid’s, are prescribed through science and evidence. We didn’t have early treatment. On the other hand, we were one of the five excellent hospitals in the country that participated in a survey on all these fronts. We deliver the results of the research to the Ministry of Health, which, from a scientific point of view, proves to be ineffective.

We had the figure of the President of the Republic, ministers and authorities questioning the effectiveness of the vaccine and, on the other hand, exalting this type of medicine.

For those on the front lines, what is the weight of this? This was not just in Brazil. Vaccine politicized everywhere in the world. Indeed, the development of the vaccine was very fast, but the technology used has been in development for a long time. Coronavirus itself is a relatively well-known virus, because others already existed.

For us, who are at the forefront, we are objective. United States, Europe and here, it was no different. An unnecessary distraction remains. For us, what mattered was the focus, the work and saving as many lives as possible.

​Now, even with advanced vaccinations, Ms. see chance for the next wave? A very personal opinion of mine, that I am not a doctor, I am an engineer, is that we are going to enter the endemic. Just like H1N1, we have to get a vaccine every year. We are in a country that takes this very seriously. People adhere to the vaccine.

The difficulty we see in Europe and the United States is that they have reached a level of vaccination and cannot go any further. I think some countries will make this mandatory, because when it comes to pandemics, it’s not just about taking care of yourself. There’s the other one, the most vulnerable.

This week, we are celebrating because we closed the Covid ICU. I opened a beautiful wine, happy with life. For me it was the event of the year because it says so much. I think that soon we will have medications addressing this issue. A drug that I think will be successful is already in phase three of clinical trials, and we are going to address those who do not want to vaccinate.

Another big theme that accelerated in the pandemic was telemedicine. What is your prediction on this? Telemedicine was provisionally regulated in the pandemic, but it is a technology that is here to stay. The concept of telemedicine is still not very well understood because people confuse it with teleconsultation, in which I call my doctor through WhatsApp and talk to him. Telemedicine is, in fact, integrated into your electronic medical record, your files. It is a consolidated technology that was already happening among health institutions.

Now, going to the consumer, this will continue. We saw telemedicine grow in BP almost 50%, 60%. Today, we have about 20% of our consultations via telemedicine. And we have an important project with RaiaDrogasil, in which anyone can enter, make their appointment and not access a hospital structure or an emergency room, which is expensive.

Are security and cyber attacks big issues too? These are very critical issues. I think every board of directors of every company, whatever it may be, should be addressing this.

I see many companies, including healthcare, talking about the digital experience up front without solving the structuring issue behind. The state of attention is enormous. We have a robust data structure at BP, with management on top of that.

Digital care isn’t just when I talk to someone on screen, it’s the entire process integrated, from drug dispensing to tracking and traceability. I want the right medicine to be given, at the right time, to the right patient.

For example, if a doctor prescribes a drug with two components that may have an inappropriate drug interaction reaction, the system already alerts. So there’s data security for an attack out there and data security for how I manage it indoors in patient care.

There is also a lot of talk about remuneration in the health service. Today, hospitals are paid for service, not quality of delivery. Should this change? Let’s walk towards it. At BP, we are already migrating a portion of compensation to this type of concept, called value-based healthcare. Today we took a line of care for a cardiology pathology and we were able to look at the entire line and pay for the outcome.

To have that, the digital transformation needs to happen. This is the difficulty when we talk about the 6,000 hospitals that Brazil has. Of these, a maximum of 30% currently have an electronic medical record. We’ve been talking about this for at least 10, 15 years. This moment we live in crisis is important to look at this current business modeling. Medicine is evolving and we are re-discussing these models.

Portuguese Charity

With 60 medical specialties served, the institution has 900 beds, 200 of which are in the ICU. Last year, it carried out 170,000 medical consultations, 29,000 chemotherapy sessions and 88,000 consultations in the emergency room.