SUSTAINABILITY REPORT 2018€¦ · Investments and prospects 35 Sustainability management 41 High...

SUSTAINABILITY REPORT 2018

German Hospital Oswaldo Cruz

SUSTAINABILITY REPORT 2018 2018

SummaryWelcome 05 Message from the Chairman of the Deliberative Council 06

Message from the Executive Superintendent 08 Our journey in 2018 10

Institution’s profile 13 Units and operations 18

Corporate governance 22 Ethics and internal controls 24

Strategy and future 26Strategic bases 31Management indicators 33

Investments and prospects 35 Sustainability management 41

High performance 44 Business performance 46

Operational Excellence 48 Medical development 53 Quality, safety and clinical outcomes 56

Innovation, Research and Education 62

Care and trust in relations 66 Patient experience 70

Human capital 73 Business partners 80

Social responsibility 82

Environment 88

Report 92GRI content summary 95

Certificates and awards 101 Credits 102

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GERMAN HOSPITAL OSWALDO CRUZ

Welcome

Continuing the commitment to transparency with patients, employees, clinical staff, associates and business partners, the German Hospital Oswaldo Cruz hereby announces its journey in 2018 through this Sustainability Report.

In the document, the Institution presents its operating structure, its vision for the future and a synthesis of finan-cial and non-financial projects and indicators that reflect its performance along the year.

Among the highlights are care for the patient's experience; investment in technology, innovation and knowledge gen-eration; and promoting social impact, with a focus on con-tributing to an improved health and access to high-quality and safe treatments.

The report was developed based on the methodology of the Global Reporting Initiative (GRI) and highlights in its pages the social, environmental and economic issues most relevant to the Institution from the perspective of its stakeholders

To access previous issues and learn more about this docu-ment, visit www.hospitaloswaldocruz.org.br

Enjoy your reading!

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SUSTAINABILITY REPORT 2018

2018: Important accomplishments consolidate our strategy

Message from the Chairman of the Deliberative Council GRI 102-14

I consider 2018 a special year for our Insti-tution, because, through the development of people, innovation, research, teaching and the promotion of social responsibility, we are able to put into practice the Immer Besserprinciple - Always doing better -, seeking high performance to ensure the best experience and health outcome in the shortest time possible for all our patients.

In a context of profound changes, pri-vate health and public health in Brazil are changing. With an increasingly val-ue-based approach focused on defined protocols, the market seeks clear results, effective and measurable costs for pa-tients. Hospitals, healthcare agreement operators and providers should think their business away from comfort zones. For our part, I am sure we are prepared to lead this transformation of the Brazilian Health market.

Several measures already implemented in our institution are proof of this. We inau-gurated the Referred Unit Oswaldo Cruz Vergueiro, which has a disruptive and innovative business model; strengthen our performance in our areas of emphasis:

With a trajectory that was built at crucial moments in the country and the evolu-tion of medicine, the German Hospital Oswaldo Cruz got to its 121 year anniver-sary with learning and a definite route to maintain its leading role in a medicine of excellence and high performance.

In 2018, we consolidated our leading posi-tion in the Latin American market, revisited our strategic planning, improved our cor-porate governance, expanded our Social Responsibility activities and structured the Innovation, Research and Education area.

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Oncology and Digestive Diseases, with the installation of specialized centers; we consolidated our performance in Social Responsibility through the management of the Estivadores Hospital Complex, carried out by our Oswaldo Cruz German Hospital Social Institute, which in two years already contributed to the municipality of Santos reaching the lowest infant mortality rate in its history; and we invested heavily in our state-of-the-art hospital infrastructure; we have structured a Patient and Family Con-sultative Council and we have carried out a detailed mapping of the journey and the experience of the users - which is already reflected in the improvement of the level of satisfaction of our audience.

I could highlight two facts that evidence our intention to go beyond the provi-sion of health services: the beginning of the deployment of the strategic plan for Innovation, Research and Education and the structuring of the Social Responsibili-ty Superintendence, for which we finished the 3rd Triennium with the execution of 18 highly relevant projects for the Unified Health System (SUS).

In this report, we are presenting a bit of our journey in 2018 in the light of the goals and plans we set for growth and ex-cellence to ensure the long-term sustain-ability of this century-old philanthropic institution, but attentive to opportunities to grow, evolve and renew.

I would like to thank our associates, pa-tients, the excellent medical and clinical staff, and our employees for their support and trust, which enable us to overcome new challenges and consolidate ourselves as one of the best healthcare institutions in Latin America.

"We are prepared to lead this transformation of the Brazilian Health market."

Julio Muñoz KampffChairman of the Deliberative Council

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MESSagESUSTAINABILITY REPORT 2018

Based on solid guidelines and consistent with the market environment in which we operate, we, who make the German Hos-pital Oswaldo Cruz every day, have gone through the year of 2018 with a strong sense of efficiency, perenniality and raising new business opportunities.

We continued the investment cycle that ma-terializes the 2016-2020 Strategic Planning and actively responded to the challenges in the country's macroeconomic framework, with a more cost-effective and sustainable business model and operation aimed at gen-erating the best results for our patients.

We closed the year with net revenue of R$ 764.029 million and invested more than R$ 45.6 million in the expansion, moderniza-tion and improvement of our infrastructure.

Aware that human capital is fundamental to achieving the strategy, we invested more than R$ 2 million in training and qualifica-tion of our employees, and in the clinical staff, we included 100% of physicians with

Efficiency and highperformance in harmony

an active registration in our Performance Evaluation Program. We also encourage sci-entific production, with 10 ongoing research in the areas of emphasis and more than 200 physicians mobilized in the Clinical Academic Program (PACC).

If quality and safety are the foundation of our excellence in handling, this is due to the adherence of each professional to protocols and reference standards: in 2018, we were once again re-accredited by the Joint Commission International (JCI) and we reached the level of six months with-out hospital infections associated with venous catheter. Our performance was superior to that of some of the best hos-pital centers in the world, and to reinforce the safety culture, we continued the daily management rituals (safety huddles) to discuss the issue with leaders of all units and implemented the Safety Rounds of the Hospital's executive body.

The vocation for care, a trait of our identity, has also been translated into several im-provements: we have advanced in the dis-semination of the Hospital German Hospital Oswaldo Cruz Model, we have implemented the Lean Model in the Emergency Sector of the Paulista Unit, we consolidated the Pharmacy automation and concluded the digitalization of the entire cycle of medi-cation distribution, with real-time checking and traceability of these inputs in the hospi-talization and ICU units.

Message from the Executive Superintendent GRI 102-14

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Technological innovation is another key issue. In 2018, the Hospital acquired a new linear particle accelerator (Halcyon™), which reduc-es irradiation from 31 to just nine steps, and a new 3 Tesla magnetic resonance imaging de-vice, capable of performing exams 25% faster. We also started to perform PET-CT tests with PSMA, to verify the existence of cells with metastasis in any part of the body, and we intend to inaugurate, in 2019, an Innovation Center, bringing other actors – such as start-ups – close to our network of relationships.

We are attentive to the digital transforma-tion that crosses the entire health service chain: to improve efficiency in patient care and increase patient safety, we are working to obtain HIMSS level 7, a certification that certifies the effectiveness of digital systems integration and the Institution’s technology site. In the field of care, we are also devel-oping specific software to support clinical and medical decision-making and investing in the digitization of processes related to clinical records.

To finish it off, I would like to highlight one of our major responsibilities as a center of excellence in health: the social one, which we have developed through partnerships with the Ministry of Health, through the Program for Support to the Institutional Development of the Unified Health System -SUS), and the administration of public hos-pitals, through the Oswaldo Cruz German Hospital Social Institute.

We will be joining in 2019 executing 21 projects of the 2018-2020 Triennium of Proadi-SUS, which we have participated in since 2008, and celebrating two years of operation of the Estivadores Hospital Complex with more than 22 thousand visits in the Obstetric Care, 424 hospitalizations in the medical clinic, 308 admissions in the adult ICU and 20,800 imaging exams, with 95.45% of users' satisfaction.

These data demonstrate the positive impact that we can generate in the public health system, contributing to raising the quality of the service provided to the population and aligning our business with the United Nations Sustainable Development Goals (ODS) – no-tably related to fostering health and welfare.

In this Sustainability Report, we present to you a synthesis of the projects developed in 2018, explain the challenges experienced in the period and announce our objectives and goals for the coming years.

We know that there are many health chal-lenges in the country, but I am sure that by generating knowledge and sharing the prac-tices and technologies that make the Oswaldo German Hospital a reference in the market, we can contribute even more to the development of Public and Private Healthcare in the Brazil.

Paulo Vasconcellos Bastian

ExecutiveSuperintendent

"We closed the year with a net revenue of R$ 764.029 million and invested more than R$ 45.6 million in the expansion, modernization and improvement of our infrastructure."

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MESSagESUSTAINABILITY REPORT 2018

OUR JOURNEY IN 2018

INDICATORS SUMMARIZING THE PERFORMANCE OF THE HOSPITAL DURING THE YEAR

8.1% INCREASE OF THE CLINICAL BODY'S ADHERENCE TO THE PROPHYLAXIS PROTOCOL IN VENOUS THROMBOEMBOLISM (VTE)

6 MONTHS WITH NO INFECTION WITH A VENOUS CATHETER

4TH ACCREDITATION BY THE JOINT COMMISSION INTERNATIONAL (JCI)

GROSS RATE OF HOSPITAL INFECTION: 0.6%

73.5% NPS: PATIENT SATISFACTION

QUaLITY aND CaRE INSURaNCE

14K ASSISTANCESIN THE COMPREHENSIVE HEALTH PROGRAM

97.5% OF ADHERENCE OF THE EMPLOYEES TO THE PERIODIC MEDICAL EXAMINATION

TaLENT DEVELOPMENT aND ENgagEMENT

aCTINg IN THE DEVELOPMENT OF HEaLTH SYSTEMS aND INITIaTIVES TO aCCESS MEDICaL TREaTMENT

21 PROADI-SUS PROJECTS WILL BE PERFORMED BY THE HOSPITAL IN THE TRIENNIUM 2018-2020, WITH R$ 217 MILLION ON TAX IMMUNITY

OVER 19K AT THE ESTIVADORES HOSPITAL COMPLEX, MANAGED BY THE OSWALDO CRUZ GERMAN HOSPITAL SOCIAL INSTITUTE

EFFICIENT ECONOMIC PERFORMaNCE IN RESOURCE UTILIZaTION

R$ 764.029 MILLION WAS THE NET REVENUE IN THE YEAR

R$ 45.6 MILLION INVESTED IN EXPANSION AND INFRASTRUCTURE

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RELaTIONSHIP WITH OPERaTORS

MORE THAN 500 PRE-DEFINED PROTOCOLS, DAILY AND GLOBAL RATES

MAINTAINED BY THE REFERENCED UNIT OSWALDO CRUZ VERGUEIRO

PRODUCTION IN VERGUEIRO: 2017: 7,134 – 2018: 35,562

398% INCREASE

INNOVaTION, RESEaRCH aND

EDUCaTION

AROUND 50 SCIENTIFIC ARTICLES PUBLISHED

10 RESEARCHES BEING IMPLEMENTED IN EMPHASIS AREAS (ONCOLOGY AND

DIGESTIVE DISEASES)

293 STUDENTS ENROLLED IN GRADUATION AND POST-GRADUATION

LATO SENSUS COURSES (FECS)

244 STUDENTS ENROLLED IN ETES COURSES

100% OF THE DOCTORS OF THE REGISTERED ACTIVE CLINICAL BODY EVALUATED IN THE

PERFORMANCE EVALUATION PROGRAM

210 PROFESSIONALS INVOLVED IN THE ACADEMIC PROGRAM OF THE CLINICAL BODY

ENgagEMENT OF THE CLINICaL BODY

ENVIRONMENTaL SUSTaINaBILITY

229 TONS OF RECYCLED RESIDUES

69,727 GJ OF ENERGY CONSUMPTION: 1.2% BELOW 2017

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SUSTAINABILITY REPORT 2018 OUR JOURNEY

Institution Profile

After completing its 121 years of history in 2018, as a reference in Brazil and Lat-in America, the Oswaldo Cruz German Hospital is a hospital center founded by German-speaking immigrants in the city of São Paulo, operating in highly complex services dedicated to assisting, treat-ing, teaching and performing research in various medical specialties, focusing on Oncology and Digestive Diseases. GRI 102-1, 102-2, 102-3

Grounded by the motto “Immer Besser” – doing better, in German -, the Institution, with a philanthropic profile, has as its prin-ciple to offer combined assistance and care to high precision therapies, with a clinical staff of more than 3,900 active registered doctors and 2,730 employees in CLT re-gime, in addition to 1,277 third parties. GRI 102-5, 102-7

The Institution's operations include three major pillars: Saúde Privada (Private Health-care) with headquarters in the region of Avenida Paulista, the Referenced Unit Oswaldo Cruz Vergueiro and the Campo Belo Unit; Innovation, Research and Educa-tion, with scientific production, generation of knowledge and offering teaching at the technical, graduation and post-graduation levels; and Social Responsibility, translated into contributions to the development of public healthcare in the country.

For eleven years ago, the Oswaldo Cruz German Hospital has been one of the five centers of excellence linked to the Program Supporting the Institutional Development of the Unified Health System (Proadi-SUS) of the Ministry of Health, with 21 projects un-der development in the 2018-2020 Trienni-um. In addition, the Oswaldo Cruz German Social Hospital Institute, established in 2014, has been managing the Estivadores Hospi-tal Complex in Santos (SP) for two years.

With a highly complex profile, the Institution is one of the largest hospital hubs in Latin America

For more than a century, the offer of medi-cal excellence, coupled with relationships of trust built with patients, family, partners and community, has contributed to the expan-sion and diversification of business. Today, through the 2016-2020 Strategic Planning, goals, indicators and capital projects seek to guarantee the competitiveness, the gen-eration of results and the social impact of the Institution in an increasingly challenging and competitive business environment, with the patient as a reason to be.

Thepast few years were transformations in care practices, with the constitution of the l Oswaldo Cruz German Hospital® Assis-tance Model; in the retention and qualifi-cation of talents, through the programs of human development and medical relation-ship; in the incorporation of new knowl-edge and technologies, with the research front; the Institute of Education and Health Sciences (IECS), the Faculty of Education in Health Sciences (FECS) and the Tech-nical School of Health Education (ETES)

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– offering graduation and post-graduation lato sensuand technical courses accredited by the Ministry of Education.

In 2018, a year marked by the continuity of the country's macroeconomic environ-ment, with direct repercussions on private health, the Hospital registered a Net Reve-nue of R$ 764.029 million, with an EBITDA of 15% in the Paulista Unit and a consoli-dated one of 4%, considering a ramp-up in the new Referenced Unit named Oswal-

do Cruz Vergueiro. It has also added R$ 147.3 million in investments (between 2017 and 2018) in the expansion of operations and registered, in the Paulista and Ver-gueiro Units, more than 24,600 hospital-izations, 140,244 outpatient appointments and 37,400 surgical procedures.

111ICU beds - total installed capacity

44 in the Paulista Avenue

30 in the Vergueiro Unit

37 in the Estivadores Hospital Complex

2,730 CLT employees

3,927 active registered physicians

805 beds - total installed capacity

582 in the private healthcare system

223 in the public sphere (Estivadores Hospital Complex)

IN FIgURES

484direct collaborators in the Estivadores Hospital Complex

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INSTITUTION PROFILESUSTAINABILITY REPORT 2018

1942The name was again changed to Oswaldo Cruz Hospital.

1972Hospital pioneered the installation of a linear accelerator used in radiotherapy.

1960Medical insurance companies are now operating in the Brazilian market.

1997In the centenary of the Hospital, the three-storey garage and a new entrance hall is inaugurated.

1991Institution adopts the name Oswaldo Cruz German Hospital

2002Inauguration of Tower B, with 14 floors, equipped with a helipad.

1980Investments in modernization, electronic controls and conclusion of the surgical center.

1914Outbreak of World War I and postponement of works.

1923Start of activities and building of the garden pavilion.

1905Acquisition of a 23,550 m² terrain in the region of Avenida Paulista.

1922Beginning of the construction of the Hospital.

1941This was a change required by the government, changing the name to Associação Hospital Rudolf Virchow.

1897Foundation of the German Hospital Association, on September 26.

HISTORICaL HIGHLIGHTS

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2015Inauguration of the Specialized Oncology Center, second re-accreditation by JCI, review of the Strategic Planning, renewal of Mission, Vision and Values and inauguration of the Premium service.

2017Celebration of the 120th anniversary of the Oswaldo Cruz German Hospital, launching of the new brand, beginning of operations of the Oswaldo Cruz Vergueiro Referenced Unit, beginning of the first graduation group in Nursing and implementation of electronic dispensaries, decentralizing the process for dispensing medications in the ICU and hospitalization units as well as the Oswaldo Cruz® German Hospital Assistance Model.

2016Onset of the implementation of the 2016-2020 Strategic Planning; The Oswaldo Cruz German Hospital Social Institute wins a public bid to manage the Estivadores Hospital Complex; formalization of the opening of the Oswaldo Cruz Vergueiro Referenced Unit.

2008Establishment of the partnership with the Ministry of Health to implement Proadi-SUS.

2014Inauguration of the Faculty of Education in Health Sciences (FECS), in the Specialized Hub for Obesity and Diabetes and creation of the Oswaldo Cruz German Social Institute.

2012Inauguration of Tower E, with 25 floors, and first JCI re-accreditation process.

2009Certified by the Joint Commission International (JCI).

2013Pillar of education attains the Technical School of Health Education (ETES).

2011Electronic prescription is adopted by the Hospital.

2018Hospital is accredited for the fourth time by JCI, inauguration of the Brain and Spine Tumor Specialist Hub, acquisition (and pioneering operation in Latin America) of the Halcyon linear particle accelerator™ and consolidation of drug traceability in digital form, in the process of medication from source to bedside. GRI 102-10

2006Expansion with Tower D, building with a restaurant and leisure and entertainment area.

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TOWER A• Image Diagnostic Center• Specialized Center on Oncology• Specialized Center in Orthopedics• Orthopedic Emergency Care• Nephrology and Dialysis • Specialty Ambulatory• Clinical Neurophysiology • Specialized Center for Tumors

in the Brain and Spine • Specialized Hernia Hub• Cardiology• Medical clinic

TOWER B• Surgery Center• Center for Cardiovascular Intervention,

Hospitalization Units, non-invasive cardiology, Day Clinic, Endoscopy and Colonoscopy

• Specialties and check-up hub

TOWER C• Emergency Center

TOWER D• Institute of Health Education

and Sciences (IECS)• Faculty of Health Sciences

Education (FECS)• Technical School of Health

Education (ETES)• Specialized Urology Center • Hub specialized in Robotic Surgery• Center for Health Care and Employee

Safety (CASSC) • Onco-hematology unit, restaurant, Gym

and Leisure and entertainment area

TOWER E• Hospitalization• Surgical Center• ICU• Rooms intended for Premium service

UNITS AND OPERATIONS GRI 102-4, 102-6, 102-7

PaULISTa UNIT

Located in the heart of São Paulo, it has 96 thousand square meters of built area and offers diagnosis, treatment, teaching and research in high complexity medicine

306 hospitalization beds

22 surgery rooms

44 ICU beds

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CampoBelo

Moema

CaMPOBELO UNIT

Located in the southern region of São Paulo, it has 1,485 m² of built area

15 rooms

SERVICES

• Infusion Center• Dizziness Center• Urinary Calculus Center• Check-up and High Endoscopy and

Colonoscopy Center• Muscular Rehabilitation Center

and Outpatient Physiotherapy• Surgical Procedures and Specialized

Multidisciplinary Care• The Unit offers consultancy in

the medical clinic, surgical clinic, cardiology, geriatrics, dermatology, gynecology, gastroenterology, coloproctology, hepatology, ophthalmology, orthopedics, otorhinolaryngology, nephrology, surgery, plastic surgery, urology, psychiatry, cardiology and pulmonology areas

• Diagnostic Services

SPECIaLIZED CENTER IN OBESITY aND DIaBETES Unit specialized in serving one of the areas of emphasis at the Institution

578 m2 of built area

SERVICES

• Multi-professional and integrated treatment for obesity and diabetes

REFERENCED UNIT OSWaLDO CRUZ VERgUEIRO With 25,500 m² of built area, has been in the business since 2017 with an innovative business model based on protocols and focusing on results for patients

232 beds (total installed capacity)

30 ICU beds

13 surgery rooms

SERVICES

• Hospitalization• ICU• Surgical Center• Specialty Centers• Diagnostic Center• Endoscopy Center• Chemotherapy

Estuário

Embaré

DowntownSANTOS (SP)

Av. Afonso Pena

Av. 23 de M

aio

Ipiranga

Mooca

Liberdade

ESTIVaDORES HOSPITaL COMPLEX Located in Santos, the unit is managed by the Oswaldo Cruz Hospital Social Institute since 2017

11,600 m2 of built area

223 beds (total installed capacity)

37 ICU beds

4 surgery rooms

SERVICES

• Diagnostic Services• Clinical care• Surgery Center• Maternal and child care• Medical clinic

MOOCa UNIT It accommodates administrative and support areas of the Institution

1,701 m2 of built areaPaULISTa UNIT

96 mil m2 of built area

306 hospitalization beds

44 ICU beds

22 surgery rooms

Corporate governance GRI 102-18

Constituted as a nonprofit association with a philanthropic profile, the Oswaldo Cruz German Hospital has its governance based on the modernization and adherence to good practices of the sector and in the market, in general. The Institution has 110 associate members, who collaborate to reflect on the future of the business and its models of contribution to Brazilian health.

The professionalization of the governing bodies, with transparent and collegiate de-cision-making processes, agility and profes-sionalism, guarantees a leadership capable of elaborating and supervising the execu-tion of the 2016-2020 Strategic Planning, in addition to monitoring the contemporary sector transformations.

STRUCTURE

• TheGeneral Assembly of Members – main body of governance. It is incumbent upon it to elect presidents and vice-presidents of the Deliberative and Fiscal Councils.

• Deliberative Council – acts in the con-struction of Strategic Planning, in the evaluation of results and in the analysis of the performance of the executives. The body comprises up to ten mem-bers, two of whom work on the annual budget, along with executive leaders. Board members receive no remunera-tion and have, as their appointment cri-teria, the pursuit of professionalism and of a vision that adheres to the hospital's long-term challenges.

• Fiscal Council – it evaluates the econom-ic-financial performance and the Institu-tion’s accounting practices. It has six mem-bers, directly linked to the top leadership.

• Executive Superintendence – it operates in strategic and operational management, executing the business plan according to key areas. Led by the CEO, it is composed of five subordinate roles: Assistance; Medical; Human Development; Innovation, Research and Education; and Social Re-sponsibility, and this one was constituted in 2018. Following instructions from the Federal Council of Medicine (CFM), there is also a clinical board, elected by the open clinical staff.

gOVERNaNCE PROCESSES

The Deliberative Council has monthly meet-ings, with the participation of the Executive Superintendence and other leaders associ-ated with the issues under discussion. The Executive Board has weekly meetings. The purpose of these meetings is to periodical-ly monitor the progress and challenges of implementing Strategic Planning.Another important forum is the Organiza-tional Performance Meeting (RPO), where-by leaders interact with direct subordinates – among coordinators, supervisors and managers – and follow the execution of projects aligned with strategy and budget.

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JULIO MUÑOZ KaMPFF CHAIRMAN

MaRCELO LaCERDa VICE PRESIDENT

LIDIA GOLDENSTEIN ADVISOR

MÁRIO PROBST COUNSELOR

EDGAR GARBADE ADVISOR

RONALD SCHAFFER ADVISOR

MARK ESSLE ADVISOR

BERNARDO WOLFSON ADVISOR

MICHaEL LEHMaNN CHAIRMAN

ERNESTO NIEMEYER FILHO VICE PRESIDENT

CHARLES KRIECK ADVISOR

KURT HUPPERICH ADVISOR

BEATE BOLTZ ADVISOR

WEBER PORTO ADVISOR

GILBERTO TURCATO JUNIOR VICE CLINICAL OFFICER

MARCELO OLIVEIRA DOS SANTOS CLINICAL DIRECTOR

PaULO VaSCONCELLOS BaSTIaN EXECUTIVE SUPERINTENDENT

CLEUSA RAMOS HUMAN DEVELOPMENT SUPERINTENDENT HUMANO

FÁTIMA SILVANA FURTADO GEROLIN ASSISTANCE SUPERINTENDENT

KENNETH ALMEIDA INNOVATION, RESEARCH AND EDUCATION SUPERINTENDENT

ANTONIO DA SILVA BASTOS NETO MEDICAL SUPERINTENDENT

ANA PAULA NEVES MARQUES DE PINHO SOCIAL RESPONSIBILITY SUPERINTENDENT

DELIBERaTIVE COUNCIL CLINIC BOaRD

FISCaL COUNCIL

EXECUTIVE MaNagEMENT

gERMaN HOSPITaL OSWaLDO CRUZ

RONALDO LEMOS ADVISOR

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ETHICS aND INTERNaL CONTROLS GRI 102-16, 103-1 | 205, 103-2 | 205, 103-3 | 205, 103-1 | 418, 103-2 | 418, 103-3 | 418, 418-1

The Oswaldo Cruz German Hospital is committed to ensuring the adoption of its standards of conduct and integrity in all relationships, practices and activities of employees, leaders and members of the clinical staff. To this end, its main instru-ments are the Integrity Program, directly

linked to the Executive Superintendence; the Ethical Conduct Manual; the activities of the Ombudsman and Internal Audit; the Confidential Channel; and the Committee on Ethical Conduct.

Dedicated to the dissemination of the subject among employees, the Integrity Program includes, among others, training and the provision of the Manual of Ethical Conduct, which addresses various issues

JULIO MUÑOZ KaMPFF CHAIRMAN

MaRCELO LaCERDa VICE PRESIDENT

FÁTIMA SILVANA FURTADO GEROLIN ADVISOR

DIETMAR FRANK ADVISOR

MÁRIO PROBST COUNSELOR

EDGAR GARBADE ADVISOR

BRUNA JACOBINA ADVISOR

ERNESTO NIEMEYER FILHO CHAIRMAN

MICHaEL LEHMaNN VICE-PRESIDENT

KURT HUPPERICH ADVISOR

BEATE BOLTZ ADVISOR

WEBER PORTO ADVISOR

PAULO VASCONCELLOS BASTIAN ADVISOR

ANTONIO DA SILVA BASTOS NETO ADVISOR

FISCaL COUNCIL

aDMINISTRaTION COUNCIL

OSWaLDO CRUZ gERMaN HOSPITaL SOCIaL INSTITUTE

ANA PAULA NEVES MARQUES DE PINHO DIRECTOR OF THE OSWALDO CRUZ GERMAN HOSPITAL SOCIAL INSTITUTE

EXECUTIVE MaNagEMENT

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related to the Hospital routine. All cases of deviation, noncompliance or potential non-compliance with the Manual of Ethical Conduct may be reported via the Confiden-tial Channel. The mechanism is managed by third parties, which, in addition to provid-ing process independence, also ensure the secrecy, integrity and privacy of all records. In 2019, the Manual of Ethical Conduct will be reviewed.

All reports are discussed by the Ethical Conduct Committee, which is formed by the managers of the Internal Audit, Legal and Human Development areas. The agency captures, analyzes and defines corrective or disciplinary measures in conjunction with the leadership of the involved.

In 2018, the Confidential Channel received 161 registrations, compared to 85 in 2017. The increase in volume is related to the greater knowledge about the tool and the compliance training sessions being per-formed, that reinforce the corporate culture on the subject.

None of the cases reported in 2018 related to alleged data privacy violations. In the Ombudsman's Office, 26 cases of attempt-ed coups were reported, resulting from fraudulent links to family members and companions for bank deposits. GRI 218-1

In order to minimize this risk, the institution has expanded the actions of clarification of patients and relatives since the act of hospitalization, reinforcing that no contact is made for payments of hospital expenses through deposit in bank account.

It is also up to the Internal Audit area to evaluate the controls adopted in the var-ious organizational processes, in order to mitigate their risks, as well as maintain a permanent training schedule.

During the year, lectures were given on topics such as workplace violence, as well as actions with the Ethical Conduct Manual and the Confidential Channel on the integration of new employees. In total,

in 2018 there were 896 participations in training that addressed these issues.

In the year 2018, the German Hospital Oswaldo Cruz did not register cases of corruption involving its representatives and activities. GRI 205-3

Committees, communication channels and management policies allow the treatment ofcompliance themes

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Strategy and future

The German Hospital Oswaldo Cruz is in-serted in a market in permanent movement. Updates on business models, technologies and therapeutic processes, care practices and relationships with commercial partners require, from hospital institutions, the ability to update themselves, in line with the evolu-tion of medicine and health systems.

With a mission to guarantee the best experi-ence and health results for its patients, with precision and humanity, the Institution has undergone a cycle of significant transforma-tions in recent years. Guided by its Strategic Planning 2016-2020, built on the careful observation of the directions of the health market of the Country and the world, has in-

vested in the expansion and in key areas for the future: Oncology and Digestive Diseases. It has also worked to increase its social con-tribution and strengthen the generation and diffusion of knowledge beyond its walls.

The review of Vision, Mission and Organi-zational Values in 2015 laid the foundations for a new strategy that draws on the Institu-tion's more than one century trajectory to reinforce competitive differentials - such as technical excellence and the vocation to the care – and guarantee its protagonism and pioneering in the incorporation of technol-ogies, in the development of human capital and in the test of new financing models and search of cost-effectiveness in health.

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mission(my daily ambition)

Being accurate and humane to ensure the best experience and health outcome for patients.

vision(The way I see the world and the healthcare system)

Full health care takes place in the harmony between knowledge and acceptance.

values(the way I do my job and nurture my relationships)

• Patient’s safety – Attention and precision to deliver the essentials to our patients: safety.

• Hosting – It is in the human touch and gaze that the deepest medicine is given.

• Truth – Trust is our means, and credibility, our end.. We are honest with ourselves and with the world around us..

• Collaborative protagonism – Collaborative leadership. Each one must play their role, but above all, take initiative, see themselves in the others and work together.

• Innovative tradition – Preservation of the culture and historical milestones of a centennial hospital, but one that knows how to reinvent itself to evolve continuously.

Oncology and Digestive Diseases mobilize priority investments

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Between 2017 and 2018, another important advance was made in the long-term plan-ning with the construction of a Strategic Planning proper for the area of Innovation, Research and Education. In line with the vi-sion of the future, this specific driver seeks to reinforce the positioning of the Oswaldo Cruz German Hospital brand in the genera-tion and diffusion of knowledge, through its own investments in research, qualified and comprehensive offer of technical and higher education and partnerships with institutions and centers of reference.

aREaS OF EMPHaSIS

One of the priorities in the definition of the strategy was to consolidate within the highly complex model – which marks the Institution's history, which is responsible for attending several specialties – a set of areas of emphasis, prioritized in terms of invest-ments, innovations and expansion.

The result of a broad reflection of the leadership, through the Deliberative Council and Superintendencies, supported by an office of corporate projects and specialized consulting, the Hospital chose Oncology and Digestive Diseases as focal points. The decision mobilizes human and material re-sources to promote differentiation in these areas, building differentiated knowledge in high complexity and gaining prominence in frontier areas for contemporary medicine.

The performance in Oncology responds to one of the greatest challenges of public and private health on a global scale. The World Health Organization (WHO) estimates about 27 million cancer cases in the global population by 2030. In Brazil, the National Cancer Institute (Inca) estimates 600,000 cancer occurrences each year, in the bienni-um 2018-2019 – highlighting non-melanoma skin cancer, which should register 170,000 new cases.

Aware of its potential contribution to the subject, the Hospital inaugurated the Specialized Oncology Center in 2015, consolidating a multi-professional team

responsible for combating the disease in an innovative, precise and cost-effective and resolvable way.

The continuous evolution in the segment occurs with measures such as the reorgani-zation of the center in sub-specialty areas, made in 2018 (read more on page 48); the qualification of the clinical staff and health professionals specialized in oncology; and the incorporation of new technologies.

The area of Digestive Diseases, in turn, encompasses a broad spectrum of spe-cialties that make up the institution's history, with care, detection, treatment and rehabilitation in gastroenterology and digestive surgeries. Today, three centers are dedicated to the area: the Center Specialized in Obesity and Diabetes; the Hernia Center; and the Spe-

Combat to cancer

Oncology area expected to serve 27 million people

worldwide by 2030

29

STRaTEgY aND FUTURESUSTAINABILITY REPORT 2018

cialized Endoscopy Center. There are also areas dedicated to the General Surgery of the Digestive System and Abdominal Wall, as well as the Campo Belo Unit – with diagnostic procedures focused on the area.

In addition to the areas of emphasis, the German Hospital Oswaldo Cruz has regis-

tered, in recent years, expressive growth in interface areas such as neurology, maintains tradition in specialties such as cardiology, orthopedics, nephrology and urology and invests in new procedures - such as robotic surgery - to generate value in health for pa-tients, in line with the vanguard of science and medicine.

ONCOLOgY SURgERIES ONCOLOgY aPPOINTMENTS

2017

6,834****

2018

10,222****

2016

4,610****2016

3,651****

DIgESTIVE SURgERIES

2017

3.870*

2018

3,783*

ENDOSCOPIES

2017

13,840 **

2018

15,924 **

2016

13,296 ***

2016

3,781****

COLONOSCOPIES

2017

10,145**

2018

11,325 **

2016

9,719 ***

* Paulista and Vergueiro units.** Paulista, Vergueiro and Campo Belo units*** Paulista and Campo Belo units.**** Paulista unit

2017

3,663*

2018

4,039*

20.5%INCREASE IN THE VOLUME OF ONCOLOGY ASSISTANCES (2017 X 2018)

30


Strategic Bases

3. EXPANSION AND CAPILLARITY

Action focus: growing in an organic and inorganic way, with new beds, opening of advanced and specialized units and part-nerships with the public and private sectors

In 2018: 398% growth in the volume of production of the Referred Unit Oswaldo Cruz Vergueiro

4. HUMAN DEVELOPMENT

Action focus: attracting, retaining and qual-ifying employees of the Institution, giving impetus to the leading role, to the collabo-rative culture and innovation

In 2018: R$ 2,050,000.00 invested in train-ing and education

To guide the implementation of the Strategic Planning, the Oswaldo Cruz German Hospital defined 8 strategic bases and 18 strategic programs linked to them. As the responsibility of Superintendencies, they are periodically monitored and help to measure the effectiveness of the business plan.

Check out the basics of strategy and highlights of the year:

1. BRAND STRENGTHENING

Action focus: increasing investments in communication and marketing; strengthening the presence of the institution's brand in the media, raising potential and current patients

In 2018: an external research found a rel-evant growth in image share, in addition to almost 1.2 million followers of the Insti-tution in social media, such as Facebook, Linkedln and Instagram.

2. OPERATIONAL EFFICIENCY

Action Focus: to improve the patient's ex-perience, with the delivery of the best result with cost-effectiveness, quality and safety of assistance and surgical processes

In 2018: 73.5% was the result of the Net Promoter Score (NPS); 22.5% reduction in waiting time in the Emergency Call

2017

6,834****

2018

10,222****

31


5. SOCIAL RESPONSIBILITY

Action focus: positively impact Brazilian health, acting in partnerships and agreements with governments and institutions and oper-ating in the management of public hospitals

In 2018: 36% reduction of infant mortality in Santos in relation to 2012, reflecting the operation of the Estivadores Hospital Com-plex; R$ 217 million in tax immunity in the 2018-2020 triennium of Proadi-SUS

6. EDUCATION AND RESEARCH

Action focus: encourage the production and diffusion of knowledge inside and outside the Institution walls, applying new technologies, training new health profes-sionals and reinforcing business results in these pillars

In 2018: seven surveys were initiated

7. RELATIONSHIPS

WITH DOCTOR

Action focus: achieving an effective en-gagement with the active registered clinical staff with emphasis on the development and retention of differentiated professionals through mutual gain relationship models and the incentive to research and excellence

In 2018: 210 professionals covered by the Clinical Program Academic Program

8. RELATIONSHIP

WITH OPERATORS

Action focus: make trading and negotiation processes more efficient, transparent and beneficial, with mutual earnings based on profitability and excellence

In 2018: establishment of three partner-ships with large operators in an innovative and disruptive model, with greater pre-dictability of prices and shared risk; the highlight was the Oswaldo Cruz Vergueiro Referenced Unit, which had a 398% leap in production volume

32


Management indicatorsLinked to the driving axes and the strategic programs, the key performance indicators (KPI) of the Hospital reflect the results of the Strategic Planning application in as-pects such as efficiency in the use of assets,

generation of knowledge and performance in areas-emphasis, economic-financial man-agement, patient and employee satisfaction and social impact of the business. Check out some of the results:

BED ROTaTIONWhat it is: it indicates the ratio between speed, efficacy and occupation of hospital beds. It is calculated based on the quantity of releases/number of beds x amount of months.

2016 2017 2018

5.20 5.25 5.28

RESEaRCH IN aREaS-EMPHaSISWhat it is: it points out how many of the Institution's researches approach the areas contemplated in the growth strategy.

2016 2017 2018

2 4 10

aVERagE RECEIVINg TIME*

What it is: it indicates the number of days that the institution takes to receive the credit for the services provided.

2016 2017 2018

140.48 132.10 129.52*PMR (without the discount of the Allowance for doubtful accounts (PDD)): accounts receivable/total net revenue x days.

PaRTICIPaTION OF aREaS-EMPHaSIS ON REVENUEWhat it is: it indicates the volume of economic-financial results of the Hospital linked to the Oncology and Digestive Diseases areas.

2016 2017 2018

47.6%* 50.0% 49.0%*Amended to allow comparability with year 2017.

FINaL STUDENTS IN aREaS-EMPHaSIS COURSESWhat it is: Gross enrollment in undergraduate courses in areas of emphasis, such as spe-cializations in oncology nursing, bariatric and metabolic surgery, and digestive endoscopy.

2016 2017 2018

6 6 49

33


PROVISION FOR DOUBTFUL aCCOUNTS***

What it is: it points out the volume of non-received resources that the Institution considers uncertain as to the receipt. As internal policy, it is stipulated that all securities receivable after 60 days of maturity must have 50% of their respective amounts provisioned as a DDA (Allowance for doubtful accounts). After 120 days, 100%.

2016 2017 2018

R$ 22.4 MILLION R$ 2 MILLION** R$ 12 MILLION

* Values corrected in relation to that reported in 2016.** The variation shown in the table above was due to the agreements made with the health plan operators.*** This information refers to the consolidated statement of all the units of the Oswaldo Cruz German Hospital.

NET PROMOTER SCORE (%) - PaTIENT'S EXPERIENCEWhat it is: it evaluates the patient's intention to recommend the hospital.

2016 2017 2018

73.5% 74.2% 73.5%

LIVES aSSISTED BY THE SOCIaL INSTITUTEWhat it is: total number of assistances in the O.S. operation Santos – Estivadores Hospi-tal Complex.

2017 2018

12,780 19,054

EMPLOYEE SaTISFaCTIONWhat it is: a percentage of satisfaction and well-being, measured by means of a Sample Organizational Climate Survey, carried out every two years by the National Association of Private Hospitals in partnership with the Koren Ferry/Hay Group.

2016 2018

70% 70%

* In 2018, a sample climate survey was conducted, with 56% of the employees invited (total of 223 respondents).

NET REVENUE (R$ K)What is: The institution’s total billing

2016 2017 2018

694,728 765,049 764,029

CONTRIBUTION OF THE aCaDEMIC PROgRaM OF THE CLINICaL BODY (PaCC) IN THE NET REVENUE What it is: sum of the net income of physicians encouraged by the PACC, divided by the net revenue of the hospital and multiplied by 100.

2016 2017 2018

13% 20.7% 23.6%

34


Investments and perspectivesUnder the influence of the macroeconomic framework experienced in Brazil in recent years, the health segment coexists with challenges that directly affect institutions such as the Oswaldo Cruz German Hospital.

According to data from the World Bank, the private health spending accounted for 4.5% of Brazil's Gross Domestic Product (GDP) in 2014. Expenditure on the public system was 3.8% of GDP, according to data from the National Treasury, an amount close to the Latin American and Caribbeanaverage (3.6%) and lower than that of the Orga-nization for the Economic Cooperation and Development (OECD), which is 6.5%1. The magnitude of the private market is connected to the general improvement in the population's living conditions, greater access to health services and the transition

process, with a leap in the elderly popu-lation – today, 8.2% of Brazilians are 65 or older, according to the World Bank – and, of course, a greater demand for laboratory services, procedures and tests.

This equation becomes even more com-plex for hospitals and health agreement operators because of the challenges linked to profitability and the cost curve of med-icines, technologies and the remuneration of skilled labor. Between 2012 and 2017, the accumulated readjustment of pharmaceu-tical products was 43.67%; of laboratory and hospital services, 45.85%; and health agreements, 85.46% (data from the Bra-zilian Institute of Geography and Statistics - IBGE). In 2017 alone, the price variation in health and personal care accumulated a leap of 6.52%.

Projects and investments prepare the Institution to meet the growing volume of users of health services

1 http://twixar.me/x5TK

Paulista Unit ICU

35

When crossed with the number of ben-eficiaries of private health agreements plans – more than 47.3 million, according to the National Agency of Supplementary Health (ANS) –, on one hand, these data point to a market with a significant poten-tial for expansion; on the other hand, it is facing structural challenges in its business models, especially regarding the relations between operators, users and hospitals of high complexity.

In view of this scenario, the Oswaldo Cruz Hospital acts through its strategic projects to raise business opportunities and mini-mize risks, with an integrated action in the areas of Private Health, Social Responsibili-ty and Innovation, Research and Education. By its philanthropic nature, the Institution reinvests 100% of its surplus result in the business itself – and, therefore, understands that the generation of results is a means to qualify the operation and offer services

that are increasingly efficient, effective and innovative to patients.

It is incumbent upon the Business Intelli-gence area to map and develop qualified databases that allow the Institution to evaluate the progress of its actions, either through dashboards that are customized or by mining and discovery (since the bases present details of the processes). Currently, there are more than 30 bases that support information from several areas. In the last eight years, the Oswaldo Cruz German Hos-pital has invested more than R$ 35.3 million in Information and Communication Technol-ogy (ICT), with R$ 15 million in software and R$ 20.3 million in hardware.

Among the highlights of recent years are the test of new business models, the devel-opment of products in population health management and the strengthening of the brand in the operation of public hospitals.

Robô Da Vinci SI

36


REFERENCED UNIT OSWaLDO CRUZ VERgUEIRO

The unit was inaugurated in the second half of 2017, with a total installed capacity of 232 beds and 25,500 m² of constructed area. During the year 2018, it hosted patients for 19,447 appointments and 4,161 surgical pro-cedures of medium and high complexity.

Conceived with a disruptive business mod-el that responds to the challenges of the Brazilian health market, the unit maintains closed prices for more than 500 pre-de-fined protocols in the areas of oncology, cardiology, orthopedics, neurology, urol-ogy, bucomaxillofacial, digestive diseases , among others, besides daily and closed global rates for exams, chemotherapy and clinical hospitalizations. With this, health agreement operators have access to care protocols defined by the Hospital, which operates with the best possible outcomes for patients, with quality, safety and cost-effectiveness.

The model, which is being implemented today, is considered a change of thought for the whole industry, changing the pattern of payment and cost per volume of produc-tion in each case served – known in English as fee for service – by an approach based on bundles or other forms of remuneration, sharing risks and mutual gains for the Hos-pital and its business partners.

The challenging environment of the last year, with an impact on the economy and on employability, has impacted the num-ber of lives in the Supplementary Health-care System.

During the year, the partnership with oper-ators for the referenced attention was ad-vanced, a process that should be deepened in the coming years. Investments were also made in the provision of services and in the construction of an emergency referenced to the new model, available for patients assisted by plans included in the referenced model. The expectation is to expand this model in the coming years, in order to in-crease its contribution in the generation of gross revenue of the Institution.

In December 2018, the Referred Unit Oswal-do Cruz Vergueiro was authorized by the Technical Chamber of the Ministry of Health to perform solid organ transplants (liver, kidney, pancreas and kidney-pancreas).

EXaMS IN THE IMagE DIagNOSIS HUB (CDI)

2017

2,0262018

7,615

SURgICaL PROCEDURES IN VERgUEIRO

2017

6842018

4,161

EMPLOYEES IN THE UNIT

2017

3472018

321

NOTE: As the Unit was inaugurated in 2017, there is no data for 2016

37


NEW PRODUCTS aND SERVICES

Parallel to the expansion of its capacity, the Institution works in search of business solutions that contribute to innovation in the provision of services – focusing on seg-ments such as population health manage-ment, primary health and the management of preventive and wellness programs in partner companies and organizations, key aspects of the future of the health market.

Reflection of the eight years of experience with the Wellness Program, implemented by the Center for Attention to Employees' Health and Safety (CASSC) and nationally and internationally recognized for its results (read more on page 73), the Institution worked on the development of its own product – through which it provides con-sulting in the corporate branch.

Under the name Saúde Integral (Compre-hensive Health), the program has several functionalities –including a toll free central office, in which employees from compa-nies that have hired the service can answer questions with nurses or family physicians 24 hours a day, as well as schedule appoint-ments and procedures – ensuring a greater focus and performance in primary care, with benefits in reducing volume in emergency care, resulting from preventive action.

Another tool already implemented in the Institution is the Sabes (Health and Well-be-ing Always) application, which contributes to the prevention and control of expenses associated with claims and health treat-ments. The data are systematized in the ap-plication, gathering life information, medical history and drug consumption, and then used for the study and mapping of trends that subsidize the construction of custom-ized health policy action plans, according to the profile of the employees and the risks associated with each.

This population health management tool was built on internationally renowned safe-ty and confidentiality protocols, using the accreditation manual by the Joint Commis-sion International (JCI) as a reference.

The offer of the service, initially aimed at the Institution's employees, as business, is connected to the trend of cost reduction in health through primary care. Data from a study in 34 countries of the Organization for Economic Cooperation and Develop-ment (OECD) show that each dollar invest-ed in prevention generates savings of $ 4 in health services.

In 2018, the Hospital established a commer-cial partnership with a company in São Pau-lo, encompassing about 3,800 lives. As part of the business, the Institution structured a primary care outpatient clinic in the client's own headquarters.

Institution's strategy prioritizes critical health sector issues, such as cost-effectiveness, adherence to protocols and innovation in business models

38


INCORPORaTINg TECHNOLOgIES

The offer of state-of-the-art healthcare solutions is part of the history of the Oswal-do Cruz German Hospital. The institution was, for example, a pioneer in the installa-tion of a linear accelerator used in radio-therapy, in 1972, taking the lead in acquiring equipment and performing procedures that reinforce health outcomes and qualify patient experience.

The year 2018 registered three major mile-stones. The Hospital performed the first surgery in Latin America to treat lumbar spine tumor with a single dosage of ra-diotherapy associated with a kyphoplasty procedure using Intrabeam, intraoperative radiotherapy equipment purchased and used since 2014.

Another highlight was the acquisition during the year of a new linear particle accelerator (Halcyon™) that optimizes the

irradiation process, reducing from 31 to only nine the steps in the radiotherapeu-tic processes. The gain of four to seven minutes per patient compared to current technologies allows the duration of each treatment to be reduced to no more than eight minutes (against 12 and 25 minutes of the current accelerators), increasing the capacity of the institution to treat up to 50% more people per hour. Targeting $ 2 million in investments, the equipment enables accuracy and effectiveness, with benefits to patient well-being and Hospital operational excellence.

The Center for Diagnostic Imaging (CDI) also recorded the acquisition of a new 3 Tesla Magnetic Resonance Imaging - equipment capable of generating high definition images in the analysis of organs and body structures, especially in the areas of neurology and oncology , be-sides having a larger opening, 70 centi-meters. By 2019, the expectation is that

Innovation Center and Research CenterAs part of the Institution's Innovation, Re-search and Education strategy (read more on page64), is in the horizon of investments for 2019 to obtain two new spaces dedicated to the study, testing and implementation of innovations in the health area. The Research and Innovation Centers of the Oswaldo Cruz German Hospital are due to open in Septem-ber, in the central region of São Paulo.

Laboratory

39


39

the technology will allow a productivity increase of 60%, lasting 20 to 30 minutes per examination and greater comfort and well-being to the patient.

In early 2019, the Hospital continued to invest in technology and began to perform the PET-CT procedure with Gallium68-PS-MA (Prostate Specific Membrane Antigen).

The test is a tool of nuclear medicine with high performance in the diagnosis of pa-

tients with prostate cancer, allowing the visualization of whole body images, made after endovenous injection of PSMA, with marking of prostate tumor cells or cells resulting from metastases in other organs of the body. The test is a tool of nuclear medi-cine with high performance in the diagnosis of patients with prostate cancer, allowing the visualization of whole body images, made after an endovenous injection of PSMA, thus marking prostate tumor cells or cells result-ing from metastases in other body organs.

ESTIVaDORES HOSPITaL COMPLEXResources received for management

2017

R$ 54.8 MILLION

2018

R$ 68.3 MILLION

ESTIVaDORES HOSPITaL COMPLEX

As one of the pillars of the Hospital, Social Responsibility has gained even greater relevance for the business since the begin-ning, in 2016, of the management of the Estivadores Hospital Complex in Santos (SP), by the Oswaldo Cruz Hospital Insti-tute, in the model of social organizations in healthcare (OS).

Conquered via public call, the operation of the general hospital, focused on the seg-ment of medium complexity and the service through regulation of the health of the mu-nicipality in the areas of maternal and child, surgical, clinical and clinical-surgical care, completed two years in February 2019, bringing together positive indicators.

In 2018, the service volume was comprised of 2,319 deliveries, 11,604 emergency ob-stetric care visits, 394 hospitalizations at the Medical Clinic, 295 admissions at the

adult ICU and 17,045 imaging exams. Also noteworthy for the implementation of the Oswaldo Cruz German Hospital Assistance Model and the sharing of technical exper-tise between the teams of the São Paulo and Santos units, which resulted in the recognition of the local population, as well as improvements in the health indicators of the Baixada Santista.

In addition, in 2018 the municipality of Santos recorded the lowest infant mortality rate in its history – under the influence of the quality and safety indicators obtained in the unit.

During the year, the Social Institute received R$ 68.3 million for application in the man-agement of the Estivadores Hospital Com-plex. The hospital is also in the process of expansion – with the prospect of expanding its capacity to serve the population, encom-passing Santos and other municipalities in the region. Today, it has 131 beds – and, still in 2019, should reach the total capacity of 223 active beds.

NOTE: As the Unit started its activities in 2017, there is no data for 2016

40


Sustainability management GRI 102-42, 102-43, 102-44, 102-47

This journey began in 2016, when, in ac-cordance with the guidelines of the Global Reporting Initiative (GRI) for building sustainability reports, the Institution con-ducted a direct inquiry with the relation-ship audiences, generating its first list of material themes.

This process, named materiality, had online stages (with more than 1.1 thousand partici-pations from suppliers, experts, employees, clinical staff, journalists and health agreement operators) and interviews with leaders and representatives of the sector. In the end, eight financial and non-financial themes were mapped as more relevant by stakeholders.

The topics deal with themes directly relat-ed to the 2016-2020 Strategic Planning, including quality and safety, efficiency in economic and financial management, innovation, research and education and human development, as well as highlighting the relevance of topics such as resource

efficiency and the control of the environ-mental impact of the operation. They are also thematically aligned with the United Nations Sustainable Development Goals (ODS), which encompass access to health, well-being, responsible consumption and decent work. GRI 102-12

Between 2018 and 2019, this process was revisited in order to deepen the under-standing of the main challenges facing the Hospital within each of the eight material themes. For this, once again face-to-face interviews were conducted with the Super-intendencies, as well as analyzes of sectoral materials and management documents of the Institution and an online appointment with more than 400 participation of audi-ences such as employees, patients, doctors, leadership, suppliers and representatives from health agreement operators. As a result, challenges associated with each hos-pital theme were mapped. The result of this review can be seen on the following page.

The incorporation of criteria and social and environmental aspects into the strategic decisions is part of the challenges horizon of the Oswaldo Cruz German Hospital. Inserted in a business sector with its own impacts, ranging from contributing to the generation of scientific knowledge and access to health services to the consumption of natural resources, the Hospital works to engage and dialogue with its main audiences to evolve in the construction of an agenda with sustainability topics.

41


MaTERIaL THEMES aMBITION CHaLLENgESEXTENSION OF THE IMPaCTS* GRI 102-40

RELaTED gRI DISCLOSURES

HOSPITaL’S STRaTEgIC THEMES ODS

Assistance quality and safety

Differentiated care in patients' individ-ualized, comprehensive and humanized assistance, focused on their needs and their families' needs. Types of services provided, treatment outcomes and safety in relation to patient data, medical records and other tools that ensure patient well-being

• Greater integration between sectors• A comprehensive look at the

experience of patients as a whole• Insertion of the clinical staff in

quality and safety processes• Work volume and adherence

to protocols

ManagersEmployeesPatientsHealthcare operatorsPhysiciansPressSuppliersCompetitors

102-43102-44416-1416-2417-1418-1419-1

• Operational efficiency

• Social Responsibility

SAÚDE EBEM-ESTAR

Development and engagement of talents

Training, professional qualification and academic staff and performance management

• Engagement of professionals developed by the Institution

• Recognition of deliveries by professionals

Board of DirectorsManagersEmployeesPatientsHealthcare operatorsSuppliers

102-8102-41401-1404-1404-3

• Human Development

• Innovation, Research and Education

QUALIDADEEDUCAÇÃO DE

Acting in the development of health systems and initiatives to access medical treatment

Offering quality service to the low-income population, in addition to serving and contributing to the development of SUS

• Improved care for the least favored population

• Increased capillarity and enhancement of the brand

• Management of changes in the supplementary health market

Board of DirectorsPressSuppliersHealthcare operators

203-2413-1



SAÚDE EBEM-ESTAR

PAZ, JUSTIÇA EINSTITUIÇÕESEFICAZES

PARCERIAS E MEIOSDE IMPLEMENTAÇÃO

Efficient economic performance in the use of resources

Business model and revenue before the increase in operations and the need to maintain quality of services

• New business model of the Oswaldo Cruz Vergueiro Referenced Unit

• Greater integration of specialties• Search for new partners and

suppliers for the innovative model

Board of Directors 419-1• Expansion and

Capillarity

TRABALHO DECENTEE CRESCIMENTOECONÔMICO

Engagement of the clinical body

Loyalty, benefits offered, Career Plan and Tools for Evaluating Physician Performance

• Greater involvement in the hospital's decision-making processes

• Proximity of the Medical Relationship area with professionals

• Stimulus to increasing the bond with the physicians

PhysiciansInstitution’s strategic indicators

• Relationship with Physicians

• Brand strengthening

SAÚDE EBEM-ESTAR



Relationship with operators

Participation of operators in hospital revenue and maintenance of commercial relations

• Change of remuneration models and medical

Physicians

201-1201-4205-3419-1


• Relationship with operators


Innovation, Research and Education

Valuing production, management and dissemination of knowledge, seeking innovation in processes and technologies in healthcare

• Improvement in information systems for collecting research data

• Incentive to academic production inside the hospital

Board of DirectorsInstitution’s strategic indicators



QUALIDADEEDUCAÇÃO DE INDÚSTRIA, INOVAÇÃO

E INFRAESTRUTURA

Environmental Sustainability

Efficiency in the use of natural resources and control of impacts, focusing on issues of emissions/energy, waste and water

• Consumption of water and materials (paper)

Board of Directors302-1303-1



CONSUMO EPRODUÇÃORESPONSÁVEIS

* The extent of impacts indicates the main internal and external audiences that emphasized the relevance of the themes during the inquiry and prioritization process.

42


MaTERIaL THEMES aMBITION CHaLLENgESEXTENSION OF THE IMPaCTS* GRI 102-40

RELaTED gRI DISCLOSURES

HOSPITaL’S STRaTEgIC THEMES ODS

Assistance quality and safety

Differentiated care in patients' individ-ualized, comprehensive and humanized assistance, focused on their needs and their families' needs. Types of services provided, treatment outcomes and safety in relation to patient data, medical records and other tools that ensure patient well-being

• Greater integration between sectors• A comprehensive look at the

experience of patients as a whole• Insertion of the clinical staff in

quality and safety processes• Work volume and adherence

to protocols

ManagersEmployeesPatientsHealthcare operatorsPhysiciansPressSuppliersCompetitors

102-43102-44416-1416-2417-1418-1419-1



SAÚDE EBEM-ESTAR

Development and engagement of talents

Training, professional qualification and academic staff and performance management

• Engagement of professionals developed by the Institution

• Recognition of deliveries by professionals

Board of DirectorsManagersEmployeesPatientsHealthcare operatorsSuppliers

102-8102-41401-1404-1404-3

• Human Development


QUALIDADEEDUCAÇÃO DE

Acting in the development of health systems and initiatives to access medical treatment

Offering quality service to the low-income population, in addition to serving and contributing to the development of SUS

• Improved care for the least favored population

• Increased capillarity and enhancement of the brand

• Management of changes in the supplementary health market

Board of DirectorsPressSuppliersHealthcare operators

203-2413-1



SAÚDE EBEM-ESTAR



Efficient economic performance in the use of resources

Business model and revenue before the increase in operations and the need to maintain quality of services

• New business model of the Oswaldo Cruz Vergueiro Referenced Unit

• Greater integration of specialties• Search for new partners and

suppliers for the innovative model

Board of Directors 419-1• Expansion and

Capillarity

TRABALHO DECENTEE CRESCIMENTOECONÔMICO

Engagement of the clinical body

Loyalty, benefits offered, Career Plan and Tools for Evaluating Physician Performance

• Greater involvement in the hospital's decision-making processes

• Proximity of the Medical Relationship area with professionals

• Stimulus to increasing the bond with the physicians

PhysiciansInstitution’s strategic indicators

• Relationship with Physicians


SAÚDE EBEM-ESTAR



Relationship with operators

Participation of operators in hospital revenue and maintenance of commercial relations

• Change of remuneration models and medical

Physicians

201-1201-4205-3419-1


• Relationship with operators



Valuing production, management and dissemination of knowledge, seeking innovation in processes and technologies in healthcare

• Improvement in information systems for collecting research data

• Incentive to academic production inside the hospital

Board of DirectorsInstitution’s strategic indicators



QUALIDADEEDUCAÇÃO DE INDÚSTRIA, INOVAÇÃO

E INFRAESTRUTURA

Environmental Sustainability

Efficiency in the use of natural resources and control of impacts, focusing on issues of emissions/energy, waste and water

• Consumption of water and materials (paper)

Board of Directors302-1303-1



CONSUMO EPRODUÇÃORESPONSÁVEIS

** In this cycle, the Hospital chose to disclose indicators 201-3 and 401-2, although they are not part of the materiality.

43


High performance

At the Oswaldo Cruz German Hospital, the definition of high performance necessar-ily passes by the concept present in the German expression Immer Besser - which means "doing better". In other words, operational excellence, high standards of quality and safety, and research and innovation efforts are all at the service

of the patients. Delivering the best out-come, the best treatment, in the shortest possible time and with the best result are inseparable premises – both in the strate-gy that guides the managerial decisions in the organization and in the more practical aspects of the Hospital’s daily routine.

Business performance GRI 103-1 | 201, 103-2 | 201, 103-3 | 201, 201-1

four months of the year. There was an in-crease in revenue in the areas of Oncology and Digestive Diseases.

The net revenue of the Hospital as a whole remained at the same level. As for the net income of the Oswaldo Cruz Vergueiro Ref-erenced Unit – still in the implementation phase, amazingly enough – increased R$ 14 million from 2017 to 2018.

The year of 2018 was quite challenging, as a consequence of the recession of which the country has not yet been completely free. Under the impact of unemployment, which resulted in a significant decrease in the number of lives in the portfolios of health care providers, the institutions had to seek new ways to maintain the results.

If, in 2017, the greatest financial highlight was the growth of the oncology and inpa-tient areas, 2018 felt the market pressure on new forms of negotiation and flattening of the margins. The highlight of the year was the growth curve of the Oswaldo Cruz Vergueiro Referenced Unit, which shows a significant evolution, especially in the last

Technical excellence and use of resources is a requirement for compliance with the Hospital Strategic Plan

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VaLUE gENERaTION aND DISTRIBUTION

DIRECT ECONOMIC VaLUE gENERaTED (R$ K)

gENERaTED 2016 2017 2018

Revenues R$ 730,039 R$ 829,510 R$ 818,527

DISTRIBUTED ECONOMIC aMOUNT (R$ K)

DISTRIBUTED 2016* 2017* 2018

Wages and benefits R$ 274,464 R$ 334,965 R$ 353,422

Other operating expenses R$ 302,261 R$ 349,717 R$ 372,607

Application in Proadi-SUS R$ 48,469 R$ 73,308 R$ 50,618

Financial income R$ 1,562 R$ 3,343 R$ 5,865

TOTAL R$ 626,756 R$ 761,333 R$ 782,512

* Information for 2016 and 2017 has been resubmitted.

SUMMaRY OF ECONOMIC aND FINaNCIaL INDICaTORS (R$ K)

2016* 2017* 2018

Net revenue R$ 694,728 R$ 765,049 R$ 764,029

Operating surplus/(deficit) R$ 80,251 R$ 56,511 (R$ 13,522)

EBITDA R$ 109,973 R$ 92,467 R$ 31,012

Year surplus/(deficit) R$ 78,689 R$ 53,168 (R$ 19,384)

Total assets R$ 1,043,069 R$ 1,084,542 R$ 1,091,167

Net Worth R$ 820,985 R$ 874,154 R$ 854,769

INDICaTOR 1: NET REVENUE (R$ K)

2016

R$ 694,7282017

R$ 765,0492018

R$ 764,029

ECONOMIC VaLUE RETaINED (R$ K)

RETaINED 2016* 2017* 2018

Direct economic amount generated minus Economic amount distributed R$ 103,283 R$ 68,176 R$ 36,014

* Information regarding 2016 and 2017 was re-submitted not considering depreciation and taxes.

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HIgH PERFORMaNCE SUSTAINABILITY REPORT 2018

DISTRIBUTED ECONOMIC aMOUNT (%)* 2016 2017 2018

Wages and benefits 43.79 44.00 45.17

Other operating expenses 48.23 45.93 47.62

Application in Proadi-SUS 7.73 9.63 6.47

Financial Expenses 0.25 0.44 0.75

* Information for 2016 and 2017 has been resubmitted.

Operational Excellence

up, Robotic Surgery, Endoscopy , Nephrol-ogy and Dialysis, Orthopedics, Urology and Brain and Spine tumors.

HUB SPECIaLIZED IN ONCOLOgY

One of the clearest developments of the Hospital's Strategic Planning, which has chosen Oncology as one of its two areas of emphasis, was the important reorganization of personnel and departments for which the Specialized Oncology Center, which has existed since 2015, expired in 2018. The number of surgeries in the area increased from 3,663 in 2017 to 4,039 in 2018. The number of inquiries, in turn, took an even more significant leap, going from 4,610 in 2016 to 6,834 in 2017 and 10,222 in the fol-lowing year.. The figures cover the activities of the Paulista Unit and also of the Referred Unit Oswaldo Cruz Vergueiro.

The acquisition of new technologies was another great highlight of the center in 2018. The new 3 Tesla magnetic resonance imaging device, for example, is capable of performing 25% faster imaging and produc-ing better resolution images - especially in neurological and oncological cases.

Part of the Institution's strategic horizon, the achievement of high performance is di-rectly linked to projects that seek to create synergies, greater quality, effectiveness and consequently patient satisfaction, through the performance of units and specialized centers – a model in which progress has been made, especially in recent years.

On a permanent basis, leaders of the Institution monitor and discuss a series of performance indicators by center, by unit, by specialty and so on – always having in mind the Strategic Planning. Among these indicators are metrics such as bed rotation, occupancy rates for Intensive Care Units and Intensive Care Units (ICU), volume of production, patient and family satisfaction with care, quality and safety of medical practice and assistance pro-vided by the Hospital as well as the use of technologies, supplies, medicines and special materials.

In the following pages are some of these indexes and also a summary of the most important results of the main specialized centers of the Hospital – and which are part of a larger list that covers Oncology, Obesi-ty and Diabetes, Hernia, Cardiology, Check-

48


In addition, the device has an opening of 70 cm, 10 cm more than usual, which offers more comfort for all patients, espe-cially the obese.

Another great achievement was the arrival of Halcyon™, a new linear parti-cle accelerator that combines the most modern irradiation technology, known as IMRT-fast arc (IMRT-VMAT), with the most accurate daily location technique (IGRT), making It is possible for the Hospital to offer the best of today in image-guided radiotherapy. The optimized workflow of this machine allows you to reduce the irradiation process from 31 to only nine steps that last only one minute, which represents a gain of four to seven minutes

per patient compared to current technol-ogies and makes each radiation therapy lasts at most eight minutes (versus 12 and 25 minutes provided by the most common particle accelerators).

This shows the tradition that the Institu-tion has in this treatment, always prioritiz-ing the technical excellence and comfort of patients. This shows the tradition that the Institution has in this treatment, al-ways prioritizing the technical excellence and the patient’ comfort.

3 Tesla Magnetic Resonance

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DIgESTIVE DISEaSES

Because it encompasses many specialties and sub-specialties, the Digestive-area em-phasis does not have a unified center for care – the range of therapeutic and out-patient options includes hernia treatments and the Specialized Center on Obesity and Diabetes, established in 2014, is reference in the segment. During the year 2018, one of the highlights was the beginning of the institutional training program of four sur-

geons of the Digestive System in Robotic Surgery, which increased the high com-plexity of the treatment.

A total number of 3,783 digestive surgeries were performed in 2018 at the Paulista and Oswaldo Cruz Vergueiro Referenced units, as well as 6,226 visits at the Specialized Center for Obesity and Diabetes.

Indicators from the Obesity and Diabetes hub registered a leap in 2018

The Oswaldo Cruz German Hospital is the only one in Brazil whose philosophy is to treat these two chronic diseases in a multi-disciplinary and fully integrated way. There are seven endocrinologists, four surgeons, two cardiologists, one pulmonologist, two nephrologists, two psychiatrists, four nutritionists, two psychologists and two nurses (one of them is dedicated to clinical research) working in the hub. The idea is to treat obese and/or diabetic patients in whatever they need and in a highly indi-vidualized manner, going beyond bariatric surgery – which is only indicated in specific cases. The number of assistances at the hub significantly leaped between 2017 and 2018, with 15.2% more patients.

Another highlight of the center is the inte-gration between clinical practice and re-search. Active for five years, the graduation course in bariatric surgery is the one that brings together the largest number of stu-dents (between 12 to 15 per year). All clinical staff are involved in the course. Two relevant surveys linked to the center will be published in 2019. One will talk about medicines and

the other, which will have worldwide reper-cussions, compares metabolic surgery with the treatment of diabetes through medica-tions, checking medical outcomes and the incidence of nephropathy, neuropathy and retinopathy among patients.

2017

5,405appointments

2016

4,401appointments

2018

6,226appointments

202surgeries

159surgeries

276surgeries

HUB SPECIALIZED ON OBESITY AND DIABETES

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HUB SPECIALIZED IN BRAIN AND SPINE TUMORS

Created at the end of 2018, it offers patients the possibility of receiving, in the same place, diagnosis, surgical treatment and multi-professional integration with oncolo-gy, radiotherapy and rehabilitation, among other activities. The center is structured in a new model, with service packages that offer price predictability and mutual gains in prof-

itability for operators and Hospital, as well as benefits and treatment effectiveness.

The vast majority of the 521 neurological surgeries performed in 2018 fit the hub pro-file, which allows predicting a growing de-mand in this specialty in the coming years.

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SPECIaLTY CENTERS

SPECIALIZED HERNIA HUB

With a direct link to the area-emphasis of Digestive Diseases, it offers diagnosis and surgical treatments for all cases of abdomi-nal wall hernias.

SPECIALIZED CENTER IN ROBOTIC SURGERY

In its 11 years of existence, the hub – equipped with a da Vinci SI robot and state-of-the-art technology, besides having a specialized and multi-professional team – has had approximately 2,500 procedures since its inauguration. In 2018, there were 254 surgeries in its movement. Among the specialties served are urology, gynecology, gastroenterology, otorhinolaryngology and transoral procedures (removal of tumors in the mouth and throat).

SPECIALIZED CENTER IN UROLOGY A variety of screening services, such as urodynamic study, cystoscopy, small sur-geries, imaging-based prostate biopsy, are available for the treatment of diseases such as benign prostatic hyperplasia, prostatitis, prostate cancer, kidney and bladder tumors , urinary and sexual dysfunctions, urinary tract diseases and kidney stones.

OTHER SPECIaLTIES

ORTHOPEDICS

It covers treatments of the spine, hand, hip, foot, ankle, knee, shoulder, elbow and vari-ous arthroscopies, as well as arthroplasties and cell therapy. In 2018, 2,887 orthopedic surgeries were performed, compared to 2,496 in 2017.

CARDIOLOGY

Traditional in the Institution, the specialty is transversally present in the operations, in-cluding Emergency Service, ICU and surgical center, and is divided into services of general cardiology, cardiovascular intervention, nonin-vasive diagnoses, arterial hypertension, heart failure, pacemaker and arrhythmology.

NEPHROLOGY

The area serves internal and external pa-tients for replacement renal therapy, such as conventional hemodialysis, daily hemo-dialysis, hemodiafiltration, nocturnal hemo-dialysis, and peritoneal dialysis. Patients are followed up and evaluated by a multi-pro-fessional team and, in the case of hospital-ized patients, dialysis services are offered (bedside), with portable machines that go to the patient's bed. In 2018, 16,046 procedures were performed, of which 14,101 were external and 1,938 of boarding schools. Also in 2018, 46 patients were enrolled in a kidney transplant queue and 11 of them were successfully transplanted.

NEUROLOGY

Among the services offered in this import-ant specialty are, in addition to a dedicated outpatient clinic, a specific institutional pro-gram for assisting patients that have under-gone a Cerebral Vascular Accident (Stroke), in addition to a Neurological ICU.

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Medical developmentThe area of Medical Relationship, subor-dinated to the Medical Superintendence, is responsible for the development of the professionals, with activities ranging from homologation of registrations to the search for engagement in new Hos-pital projects. Today, efforts are focused on adherence to international protocols, encouraging scientific production and research, and qualifying the clinical staff, with areas of emphasis as the frontier of evolution and maturation of the model.

In harmony with the Strategic Planning, the Institution sees in the more than 3,900 phy-sicians who make up its active registered clinical body a crucial tool for the success of the business model.

It is incumbent upon these professionals, who belong to numerous specialties and subspecialties, to contribute to the Hos-pital's reputation and competitive differ-entiation, providing excellent clinical care and applying protocols and reference procedures in surgical practice, focusing on the best outcome for patients, quality and safety, and efficient use of resources.

The maintenance of the number of ac-tive registered doctors is accompanied by actions that seek to strengthen the link with values and strategy. It also reflects the expansion of operations, with the Oswaldo Cruz Vergueiro Referenced Unit (inaugurat-ed in 2017) and the new specialty centers inaugurated in recent years.

The learning of the disruptive model of the Referred Unit Oswaldo Cruz Vergueiro in the last two years was responsible for maturing the dialogue with the clinical staff.

EVOLUTION OF THE aCTIVE CLINICaL STaFF (INCLUDINg PHYSICIaNS aND MaXILLOFaCIaL SURgEONS)*

* Without considering the doctors acting in the Estivadores Hospital Complex.

2016

3,7322017

3,9432018

3,927

It was up to the professionals to contribute to the implementation of the clinical pro-tocols and packages of services based on a cost-effective approach and the genera-tion of value to patients, generating results that represent a new way of operating in private health.

In 2018, the Institution continued the four medical qualification and development programs (see it below). Moreover, it has invested in a greater understanding of the needs of professionals, with a workload

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Performance Recognition and incentive to scientific production are the foci of action

approach – similar to what has traditionally been adopted in managing the patient's experience – and active listening to critical demands and questions. This issue is espe-cially important in the areas of emphasis, in a market context of high competition by the best professionals that requires the ef-forts of the Oswaldo Cruz German Hospital to maintain attractive conditions and be the preferred brand not only for patients but also for the Healthcare professionals.

Among the foci of action in recent years are the offer of remuneration and recogni-tion models by performance – not nec-essarily surgical, also covering scientific production, for example, improvements in surgery scheduling services; digital com-

munication services and transparency in the evaluation of results; and broadening the spectrum of physicians evaluated and covered by feedback.

The results of the Performance Evaluation are currently published on an annually basis to the evaluated professionals and other stakeholders. Beginning in 2019, month-ly dissemination of the evaluation will be electronically implemented, through pub-lications on a page accessible through an individualized method. The possibility of closely monitoring the indicator will be an ally for the strategic directions of the Insti-tution and the assessed one.

ENgagEMENT PROgRaMS CLINICAL MANAGEMENTAs a basis relationship program, it returns to the evaluation and documentary and registry approval of physicians. It also de-tects needs of the clinical staff to promote training and clarifies doubts about the in-stitution. The Medical Accreditation Com-mittee, the Clinical Executive Board and the areas related to the Medical Superinten-dency are linked to the program. In 2018, a highlight was the creation of the Ambu-latory of Specialties, an action of the new outpatient management area, to promote a better patient experience.

EVALUATION PROGRAM FOR CLINICAL STAFF PERFORMANCEIn 2018, 100% of the registered clinical staff was included in this initiative – which allows the analysis and measurement of the results of the professionals working in the Hospital from several indicators, with emphasis on quality and safety criteria (adherence to protocols, filling of medical records, surgical performance), assistance/productivity and the generation of knowledge and research (titling, publications, participation in scien-tific events). During the year, a technolog-ical solution was structured that will allow, as of 2019, physicians to have monthly mea-surements of their results, with various data related to their performance in the Hospital.

54


ACADEMIC PROGRAM FOR THE CLINICAL STAFF (PACC)Revised in 2017 and 2018, the program was conducted during the year with a cycle mapping all the scientific production and research of professionals working in the Hos-pital. In 2018, 210 physicians were involved.

With a punctuation system, based on mer-itocracy and a base of 30 indicators, the PACC establishes levels that, when reached, result in support for participation in con-gresses, organization of scientific events and research. Academic indicators are also integrated into performance evaluation and are also part of the Strategic Planning Man-agement KPIs (read more on page 34).

MEDICAL OMBUDSMANStructure responsible for receiving re-cords, manifestations, complaints, doubts and compliments regarding the clinical staff on the Institution, employees and patients. Cases related to ethics, integrity and conduct are sent to relevant commit-tees and Superintendencies

55


Quality, safety and clinical outcomes GRI 102-11, 103-1 | 416, 103-2 | 416, 103-3 | 416, 103-1 | 417, 103-2 | 417, 103-3 | 417, 416-1

The results attest to the efforts made in the Quality, Patient Safety and Clinical Outcomes management system, guided by internationally recognized quality and safety standards, with indicators, protocols and processes marked by international references. In addition to risk reduction, it seeks to increase the effectiveness and efficiency of the institution's practices, the integration of services, areas, specialties centers and commissions, and to improve the patient's experience on a measurable basis comparable to the best hospitals hubs worldwide.

The re-accreditation of the Oswaldo Cruz German Hospital for the fourth time by the Joint Commission International (JCI) in 2018 represented a milestone for the Hos-pital in the areas of quality and safety. Last year, the audit was performed by a team of international auditors and with chang-es in the scoring of the elements of the manual, thus increasing the level of com-pliance requirement. Further, this was the first time that the Referred Unit Oswaldo Cruz Vergueiro came within the scope of the evaluation. The percentage of hospital compliance in relation to the criteria listed by JCI was 99.84% in 2018.

99.84% was the Hospital's compliance rate in JCI's re-accreditation

Actions are constantly taken to develop a patient safety culture in the Hospital, and this year the focus was on improving lead-ership participation in safety initiatives, pro-moting spaces and strategies where leaders can be more visible, present and a model in the application of safety guidelines. One of the highlights in this sense was the intro-duction of the Safety Rounds, conducted by the Hospital's leadership.

On another front, the monitoring and improvement of care received special attention with the control of a strategic dashboard containing Patient Quality and Safety indicators. It consists of 21 indicators, segmented into three groups: operational efficiency, risk management, and processes and outcomes.

56


OPERaTIONaL EFFICIENCY

• Net Promoter Score - Paulista Unit• Tasy System Availability Index• RIS PACS System Availability Index• Average Length of Permanence - Paulista Unit• Technology Availability Index

– Uptime Magnetic Resonances• Technology Availability Index

– Uptime Computerized Tomographies• Average waiting time for medical appointments in the Emergency Room

MaNagEMENT OF RISKS, INCIDENTS aND aCCIDENTS

• Typical work accident rate with remoteness• Number of Sentinel Events/Never Events• Patient falls resulting in injury/1000 patient days• Density of avoidable drug-related adverse events• Density of bloodstream infection associated with CVC

(hospitalization units)

Safety and Quality Indicators

aSSISTaNCE PROCESSES aND OUTCOMES - PRaCTICaL RELIaBILITY

• Surgical Mortality in up to seven days• Hospital Mortality Rate• Percentage of adherence to venous thromboembolism prophylaxis• Systemic chemotherapy given in the last 14 days of life• Sepsis lethality• Readmission Rate within 30 days after Bariatric Surgery• Readmission Rate within 30 days after Mastectomy• Readmission Rate within 30 days after Radical Prostatectomy

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IN PRaCTICE: RESULTS

The coordinated action of control and im-provement allowed one to achieve import-ant results, such as:

• Reduction in lethality rate due to sep-sis and septic shock, achieving a better performance in 2018 compared to our benchmarking (set of accredited hospi-tals, members of Anahp) and the Latin American Sepsis Institute (ILAS);

• The adherence of the Hospital's clinical staff to the Protocol of Prophylaxis in Ve-nous Thromboembolism (VTE) showed a significant improvement of 8.1% in 2018;

• It was evidenced that in 2018, the Hospi-tal spent six months without registering any venous catheter infection.

In order to achieve ever higher levels of standardization and data reliability, the Hospital invested in the validation of a larger set of indicators, which are used to support decisions in various areas and clin-ical specialties, especially those related to areas of emphasis. This work culminated in the certification of these indicators by the Brazilian Accreditation Consortium (CBA) in early 2019.

OTHER VaLIDaTED INDICaTORS

Readmission in 30 days Bariatric surgery

Readmission in 30 days Radical Prostatectomy

Readmission in 30 days Hip Arthroplasty

Readmission in 30 days Knee Arthroplasty

Current Infection Density Blood associated with CVC

Clinical Outcomes After Bariatric and Metabolic Surgery

Surgical Site Infection After Total Hip Arthroplasty

Surgical Site Infection After Total Knee Arthroplasty

30-day re-operation rate Urgency and Emergency - Cholecystectomy

30-day re-operation rate Urgency and Emergency - Appendectomy

Avg. Admission time in urgency and emergency surgery Cholecystectomy

Avg. Admission time in urgency and emergency surgery Appendectomy

Average Hospital Stay in urgency and emergency surgery Cholecystectomy

Average Hospital Stay in urgency and emergency surgery Appendectomy

Rate of surgical site infection in clean surgery

Readmission in 30 days Mastectomies

Early re-hospitalization rate (less than or equal to 24 hours) ICU

Early re-hospitalization rate (less than or equal to 48 hours) ICU

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In line with current guidelines related to value-based care, the Hospital has invested in monitoring and evaluating clinical out-comes. This can be evidenced in the set of indicators validated for institutional control, as well as through the Clinical Outcomes Monitoring Program, in which the Institu-tion participated in national initiatives, such as the partnership between the National Association of Private Hospitals (Anahp) and the International Consortium for Health Outcomes Measurement (ICHOM).

Adding value to all healthcare and medi-cal practices has been the great challenge of health institutions; this is consolidated with the activation and engagement of the patient and family, in their care and in the decisions to improve the practice. In this sense, in 2018 an unprecedented initiative was implemented to include the patient in the decisions to modify practices in the ICU. The project entitled "Inclusion of the patient/family in the release orientation process of the intensive care unit" has consulted patients and families about the improvements to be made in the release assistance process and aims to implement the modifications by April 2019. Based on the Improvement Model methodology, adapted and disseminated by the Institute for Healthcare Improvement (IHI)and using the co-production approach, it has as its main primary drivers:

This project aims to develop a set of out-comes (referred to as standard sets) for wide magnitude diseases worldwide. Initiated by the deployment of the Heart Failure (IC or HF) Standard Set, the group of participating hospitals, coordinated by Anahp, advanced in the establishment of metrics and in the structuring of indicators for benchmarking amongst institutions. Currently, hospitals can compare their performance in relation to the adherence to medication prescription for HF at release time, mean length of stay and quality of life at admission after 30 days. GRI 102-13

• Promoting the activation and engage-ment of patients in their own care and in decision-making;

• Promoting professional qualification and establishing a process that guarantees patient participation in care;

• Ensuring access to clear and relevant in-formation for care and decision-making;

• Developing a culture of inclusion and pa-tient engagement as a way to add value to assistance.

Protocols, committees, working groups and monitoring of indicators ensure a safe operation and excellence

59


SaFETY HUDDLE

Every day, representatives from all areas and units of the Hospital meet to analyze the risks present in the operation and focus efforts on eliminating them or mitigating their consequences. Partici-pating regularly, in person or by video conference, the Paulista, Campo Belo, Oswaldo Cruz Vergueiro Referenced Units, as well as the Estivadores Hos-pital Complex.

PaTIENT SaFETY COMMITTEE

Deployed in 2018, the Patient Safety Committee brings together the leadership of the Institution to discuss the incidents and adverse events that occurred in the period. Its purpose is to stimulate open communication and dissemination of learn-ing with the failures that have occurred, contribut-ing to the development of a safety culture.

QUaLITY TUESDaYS aND PaTIENT’S SaFETY

This action is an internal audit that takes place biweekly and is based on the verification of some JCI standards. The great differential is the participa-tion of employees in the assistance areas, enabling knowledge about quality standards and the expan-sion of risk vision. The graduation students in Nurs-ing and the College Course in Hospital Management Technology are also part of the discussions.

SaFETY ROUND

Superintendents and the CEO of the Institution go to the units to talk to the teams about quality and safety (patient, employee, environment and infor-mation); In this way, discourse and practice are aligned, strengthening the values of the Hospital.

SKILLS FOR PaTIENT QUaLITY aND SaFETY

In 2018, workshops were held to develop skills needed to promote improvement, including PDCA (quality tool), measurement and analysis (based on the IHI Improvement Model).

QUaLITY aND SaFETY WEEK

The awareness and commitment of all is essen-tial for the evolution of the Culture of Safety and achieve ever more expressive results. The Quality and Safety Week fulfills this objective by promoting a scientific event and a week of lectures, gymnas-tics and games on the theme.

In 2018, the Quality and Safety Week expanded the scope and brought together actions focused not only on Patient Safety, but also on Employee Safety and Information Security.

As the theme of the scientific event, we talked about Transformational Leadership and Security culture.

Patient Safety Practices

100% of the materials and inputs used in the Hospital go through evaluation processes related to quality and safety

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PERFORMaNCE IN INDICATORS AND RATES

gROSS INFECTION RaTE

0.7%

2017

0.7%

2016

0.6%

2018

RaTE OF BLOODSTREaM INFECTION aSSOCIaTED WITH PERMaNENT DIaLYSIS CaTHETER

1.4%

2017

0.6%

2016

1.7%

2018

97%

2016

RaTE OF aDHERENCE TO PROPHYLaCTIC aNTIBIOTIC aDMINISTRaTION UP TO 60 MINUTES PRIOR TO HIP aRTHROPLaSTY INCISION

2017

93%

2018

94%

77%

2016

RaTE OF aDHERENCE OF HEaLTH PROFESSIONaLS TO HaND SaNITaTION gUIDELINES

2017

62%

2018

82%

DENSITY OF PRIMaRY INFECTION OF THE BLOODSTREaM RELaTED TO CENTRaL VENOUS CaTHETER IN THE ICU(X/1,000 CATHETERS PER DAY)

80.5%

2017

73.8%

2016

88.7%

2018

12.7%

2017

15.8%

2016

9.2%

2018

LETHaLITY DUE TO SEPSIS

40.6%

2017

37.6%

2016

33%

2018

RE-ORIENTaTION RaTE OPPORTUNITIES IN THE aDMINISTRaTION OF HIgH VIgILaNCE DRUgS

PERCENTagE aDHERENCE TO PROPHYLaXIS OF VENOUS aRTHROPLaSTIES

0.8

2016 2017

0.2

2018

0.9

The index recorded in 2018 was bet-ter than the average of 1.1/1,000 day catheters of the hospitals reporting to the NHSN – National Healthcare Safety Network.

The index in 2018 was better than the average of the CVE – Epide-miological Surveillance Center of the State Health Department of São Paulo, which obtained a 3.23% percentage.

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The first of these was to clarify the align-ment between the Hospital's areas of em-phasis and public health impact research. During the year, for example, the goal was to have 10 ongoing researches linked to Oncology and Digestive Diseases, helping qualify medicine and care in these areas.

The second point was the structuring for 2019 of a new Research Center and Inno-vation Hub, in order to provide it with the necessary conditions for its activities and enable the delivery of results involving the clinical Hospital staff. The hubs now have not only with medical researchers, but also system analysts and prostatitis, for example.

The third aspect involved the increasing search for collaborative network studies in Brazil, involving hospitals and research cen-ters, so that the role of the Hospital in the area is national – not just local.

Among the main challenges for the coming years are the elaboration and conduction of projects relevant from the point of view of dimension, scope and population impact, as well as the involvement in research in pri-mary care. The researches will be evaluated for their size, relevance and reach in terms of public health. The Hospital aims to look at the existing knowledge gaps, strengthen-ing its position as a center that diffuses new ideas in medicine and practice care.

The structure dedicated to education and research in the Institution includes

With a strategy set up to strengthen the fronts of generation and diffusion of knowledge inside and outside its walls, the Oswaldo Cruz German Hospital had, in 2018, three main guiding principles for the Innovation, Research and Education activities.

the Technical School of Health Education (ETES), the Faculty of Education in Health Sciences (FECS), the Institute of Education and Health Sciences (IECS) and the Re-search Center and Innovation Hub, due to open in September 2019.

The main integration of the Hospital, the Faculty, the Technical School and the con-solidation of the practical disciplines of the courses were the main highlights in 2018.

Also important were the creation of a post-graduation degree in Oncology Neuro-surgery, the Education and Health Semi-nar (which awarded three winners for its performance, two of which were from the Faculty and one from the Hospital) and the consolidation of the program of extracurric-ular internships for technicians in areas such as the Diagnostic Imaging Center (CDI) and the ICU.

The expansion of the area of education of the Hospital is a priority of the Superinten-dence of Innovation, Research and Educa-tion. There are currently 13 postgraduate courses (five in the medical area and eight in the multi-professional area), with the expectation of rising to 22 in 2019.

Graduations, in turn, are currently the three described below: Bachelor of Nursing, Superi-or Course of Technology in Hospital Manage-ment and Technology in Radiology. There are three other courses under authorization process with the Ministry of Education.

Knowledge generated and applied to health

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Lato-sensu post-graduation in a Multi-professional Area:

Lato-sensu post-graduation in the Medical Area:

Nursing in Oncology

Nursing in Intensive Therapy

Hospital Physiotherapy

Specialization in Gerontology

Management of Services and Nursing Practices

Specialization in Clinical Research

MBA in Hospital Administration and Healthcare Management

MBA in Economics and Technology Assessment in Healthcare Extension: Coaching in Health and Welfare

Bariatric and Metabolic Surgery

Robotic Surgery in Urology

Medical clinic

Echocardiography

Oncology Neurosurgery

aCaDEMIC PaRTNERSHIPS

In the year of 2018, researchers linked to the Hospital published about 50 articles. Among them, publications with a national and international impact were highlighted – especially the following works:

• "Wet M1a non-small cell lung cancer: is it possible to predict recurrence of pleural effusion?" (Journal of Thoracic Oncology);

• "Is neoadjuvant chemoradiation with dose-escalation and consolidation chemo-therapy sufficient to increase surgery-free and distant metastases-free survival in baseline cT3 rectal cancer?" (European Journal of Surgical Oncology);

• "Association of frailty with short-term outcomes, organ support and resource use in critically ill patients." (Intensive Care Med)

In the field of partnerships with institu-tions abroad, the most important agree-ments are being elaborated in a partner-ship with theLondon School of Hygiene, Stanford University (in the area of human development, and the superintendency is working to extend this partnership to the field of innovation), Canadian McMaster University and the World Heart Federa-tion. Another partnership with a Swedish university must be formally approved in 2019. One of the focuses is to evolve in the specific partnerships linked to the Oncology area.

The Hospital has also benefited from a part-nership with information technology schol-ars from the São Paulo Faculty of Comput-er Science and Administration (FIAP). The intention of the Superintendency is to bring the Institution closer not only to univer-sities, but also to development agencies, startups and private partners who can offer innovative business solutions.

Approved projectsThe Hospital's Research Ethics Committee approved 26 research projects in 2018. These projects are conducted with the involvement of the research center and researchers responsible for the projects, professionals integrated to the clinical and multi-professional body.

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INNOVaTION, RESEaRCH aND EDUCaTIONSUSTAINABILITY REPORT 2018

Care and trust in relations

Caution: a vocation that is translated into excellence

The Oswaldo Cruz German Hospital has the quality of assistance and care as an important attribute for the consolidation of its brand. With 121 years dedicated to the reception of patients with different profiles, mainly medium and high complexities, the Institution constantly works to update and improve its practices, technologies and assistance tools, combining the precision to treat the vocation to care.

Along 2018, the Oswaldo Cruz German Hospital Care Model advanced with a series of measures, such as the installation of electronic panels and reference frames of care in the hospitalization units; the consol-idation of a tool to analyze the adherence of areas, centers and units to the model; conducting a Patient and Family Advisory Council; the adoption of traceability and

drug administration control technologies; and the dissemination of practices beyond the Paulista Unit, reaching the Estivadores Hospital Complex and acting as the founda-tion of the business model of the Oswaldo Cruz Vergueiro Referenced Unit.

The 2016-2020 Strategic Planning stipulates an integral attention to the patient's journey and considers the hospital's differentiated care history as an inducer of results. It also understands that an own care model, with protocols, methods and practices based on national and international references, is responsible for ensuring the effectiveness of treatments, obtaining optimal outcomes for each patient, maintaining the patient and the assistance team’s trust bond and the cost efficiency required for contempo-rary health.

Patient and Family Advi-sory Council

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Published as a book and disseminated through the social work of the Institution, the Oswaldo Cruz German Hospital Assis-tance Model is based on the Relationship Based Care (RBC)model and is organized in five pillars: Communication; Management; Patient Education; Quality and safety; and Professional and Personal Development.

The governance of the model deployment is made by the Model Assistance Group (GMA), dedicated to disseminate and mon-itor its practices in different areas. Besides, each hospitalized patient is informed of the commitment of each hospital employee:

• I'll try to understand what this moment means to you and to your relatives;

• I will treat with respect and ethics all that you entrust to me;

• I will strive to create a safe environment;

• I will act with transparency, and the truth is a fundamental value for our relation-ship;

• I promise to assist you in the develop-ment of your self-care, respecting your moment.

Through these commitments, the objective is to establish bonds of trust with patients and their relatives, from diagnosis to the treatment, release and recovery processes.

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CaRE aND TRUST IN RELaTIONSSUSTAINABILITY REPORT 2018

Understanding the journey that every user of the services provided by the German Hospital Oswaldo Cruz experiences is a priority for the Institution. Based on the perception of value generated and the recommendations of patients and their families, it is possible to plan process changes, implement new technologies and revise care models, in dialogue with protocols and good practices in the sector.

The year of 2018 represented an important advance in the dialogue on the subject with the first cycle of the Patient and Family Consultative Council. Through this struc-ture, people attended by the Hospital who have a history of permanence can dialogue periodically with leaders on the facilities, the assistance and the clinical staff, contributing to improvements of the Assistance Model.

During the year, six Council meetings were held, which closed its first composition in February 2019. At the time, a new group took office for a term until the following year and was able to know the lessons and experiences of the first counselors in a spe-cific ceremony.

Also during the year, there was a continuity of the Patient Experience Nucleus, subor-dinated to the Assistance Superintendence to map and identify contact points of the population served and identify opportuni-ties for improvement.

Reflecting suggestions and notes from the nucleus and the Patients and Family Con-sultative Council, as well as the mapping of good practices in international and reference institutions, several improvements were made in the assistance during 2018, highlighting:

Patient’s experience

Vocation for care translates into projects that benefit patients and family members

AUTOMATION AND TECHNOLOGY IN THE ADMINISTRATION OF MEDICINES

As a target of R$ 7.3 million in investments since 2016, the pharmacy automation proj-ect was completed in 2018 and had new ad-vances in technology, with electronic dispen-saries, robotization of the warehouse and the implementation of tools that guarantee total traceability of medicines used in health-care processes, with the electronic manage-

ment encompassing the origin and destina-tion of each drug. With the implementation of electronic dispensaries, there was a break-through in the offer of direct patient care in hospitalization units, minimizing the impact of displacement – with assistance, operation-al, financial and patient satisfaction benefits. Key indicators and results:

• 87% of the items required to serve pa-tients in hospitalization units are available at the electronic dispensary;

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• 77% reduction of time in emergency requests;

• 67% reduction in the rate of return of medicines;

• 94% reduction of patient-related in-cidents related to delays in medication administration;

• 90% decrease in complaints to the Ombudsman regarding the medication process.

BED SIDE In connection with the automation proj-ect for the drug storage and distribution processes, in 2018 the drug administration infrastructure was reorganized by using technology for real-time patient manage-ment. With the Bed side, already imple-mented in the hospitalization units and in the ICU, the administration and checking of medicines began to be carried out in a digital way, giving greater traceability and safety to the processes.

LEAN PROJECT

As part of the improvements in the level of service of the Emergency Care, all stages of patient care were studied and subjected to improvements in the lean production model; in doing so, the idea was to detect obstacles and improve them from simple solutions that include protocols, establishment of care stan-dards and estimates of time of care. With the support of a specialized consultancy, a study of patient profiles and care mod-els tailored to each patient's needs was carried out in order to guarantee patient well-being and satisfaction. As a result of the project, it was possible to reduce the waiting time for the Emergency Call by 22.5% in 2018, with an expectation of even better results in 2019.

PANELS AND REFERENCE FRAMES Electronic panels with information about the patient, based on the Oswaldo Cruz German Hospital Assistance Model, began to be implanted in the Hospitalization Units, with a view to be disseminated to other units (such as the ICU) throughout 2019. On the other hand, the reference frameworks of the model, whose implementation was started two years ago, was completed in the ICU and Emergency Care.

DE-HOSPITALIZATION NUCLEUS During 2018, discussions began on the implementation of a multi-professional nu-cleus dedicated to the study of de-hospi-talization practices, focusing on long-stay patients with conditions to have thera-peutic alternatives outside the Hospital, including gains in well-being and quality of life. The constitution of the nucleus, as well as the dialogue with health agreement op-erators, key to the discussion, should take place during 2019.

73.5%

satisfactionmeasured by NPS, above the goal established for the year 2018

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INTERDISCIPLINARY VISITS

As part of the goal of strengthening the dialogue among multi-professional teams, visits were made to patients and/or their families with the participation of phys-iotherapists, nutritionists, psychologists, pharmacists, nurses and physicians to dis-cuss specific cases. The occasions allow the exchange of data on continuous improve-ments, information for release processes and therapeutic decisions that are more appropriate to each patient.

SAFETY HUDDLE

These forums progressed through 2018, with brief meetings and security tactics on a daily basis, with interdisciplinary discus-sion and integration of care and clinical staff (read more on page 60). The Paulista, Campo Belo, the Oswaldo Cruz Vergueiro Referenced units, as well as the Estivadores Hospital Complex, participated regularly, either face-to-face or by video conference.

SaTISFaCTION SURVEY GRI 102-43, 102-44 In order to understand patients' perception of their value in care processes, the Hospital applies periodic satisfaction surveys based on the Net Promoter Score (NPS) method. Based on it, it is possible to identify and classify the promoters, neutral and detractors, who evaluate the institution and its services with grades from zero to 10.

During 2018, data collection was carried out by means of e-mails sent to patients after leaving the Hospital, with customized questionnaires according to the type of care (including examinations, hospitalization, Emergency Care, day-hospital etc.). The result of the evaluation was a NPS of 73.5%, above the established goal (73%).

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With the Strategic Planning and the chal-lenging moment lived by the private health sector within its horizon, the Superin-tendency of Human Development of the Hospital had as one of its highest priorities in 2018 the search for operational efficien-cy. Through productivity management, the area was able to meet its cost goals without compromising the level of services provided by the Hospital.

The Institution seeks more and more em-ployees whose profile fits the concept of

Human capital GRI 102-8

a department at the same time responsive and proactive, that is, able to quickly see the demands of different areas of the or-ganization and offer a different, innovative, positioning solution decision makers.

Thinking about its human capital, the hospi-tal's main highlight last year was the trans-formation of the Wellness Program into an even more structured front, Saúde Integral (“Comprehensive Health”) - which currently is a product that is even being offered to companies (read more on page 38).

Held in the scope of the Center for At-tention to Employees' Health and Safety (CASSC), Saúde Integral has as its target audience the employees working at the Hospital and its dependents over 14 years old, who started being assisted in the Net-work since September 2018, mostly in the Oswaldo Cruz German Hospital. Fully based on primary care and family medicine, in 2018 the program registered more than 14 thousand visits. There was also a 97.5% ad-herence of the hospital staff to the periodic medical examination – which, being compa-rable to a full check-up, goes far beyond the legal requirements of occupational medi-cine. CASSC has a multi-professional team

exclusively dedicated to support the em-ployees and their dependents in the sched-uling of second opinion appointments, scheduling of procedures and elective sur-geries in the Hospital units as well as in the internalization of medications and infusions.

The Welfare Program awarded the Oswal-do Cruz German Hospital the first prize in the 2018 edition of the Global Healthy Workplace Awards, dedicated to recog-nizing initiatives to promote health in working environments. Competing with more than 100 companies from all sectors, the Hospital has reached the finals and had its case displayed in Italy, in Septem-

People management prioritizes atmosphere monitoring, promotion of well-being and the urge of career development

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Employees: our profile **

NUMBER OF EMPLOYEES PER TYPE OF LaBOR CONTRaCT aND gENDER*

TYPE OF CONTRaCT

2016 2017 2018

Men Women Total Men Women Total Men Women Total

Determined time

19 76 95 14 48 62 10 34 44

Undetermined time

880 1,570 2,450 1,017 1,857 2,874 915 1,771 2,686

TOTaL 899 1,646 2,545 1,031 1,905 2,936 925 1,805 2,730

*All company units are located in the Southeast Region.

NUMBER OF EMPLOYEES BY TYPE OF EMPLOYMENT

TYPE OF CONTRaCT

2016 2017 2018

Men Women Total Men Women Total Men Women Total

Full day 422 791 1,213 482 930 1,412 609 1,146 1,755

Partial day (part time)

477 855 1,332 549 975 1,524 316 659 975

TOTaL 899 1,646 2,545 1,031 1,905 2,936 925 1,805 2,730

*All company units are located in the Southeast Region.

NUMBER OF EMPLOYEES BY agE gROUP* 2017 2018

< 30 years 694 592

From 30 to 50 years 1,962 1,922

> 50 years 280 216

TOTaL 2,936 2,730

* Physicians as Legal Entities (PJ) and outsourced companies are not considered in the total number of people reported Values also disregard the Council members.

ber 2018. The victory also resulted in a certification granted by the very Global Health Workplace Awards, valid for two years. The Oswaldo Cruz German Hospital became the only one in Latin America to have such a distinction.

Other areas of attention in people manage-ment include the retention of talents, the monitoring of career possibilities and the enhancement of knowledge and innovation. The management of third parties is done directly by the areas, with support from the Supplies sector and monitoring of the performance of these professionals done directly by employers.

** The tables do not include the physicians

from the registered active clinical body,

who serve the institution in the Legal

Entity model (PJ).

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NUMBER OF EMPLOYEES BY FUNCTIONaL CaTEgORY* 2016 2017 2018

Board of Directors 6 6 5

Management 26 35 29

Leadership/coordination 71 92 87

Technical/supervision 25 22 25

Technical 302 778 770

Administrative 512 587 519

Operational 1,502 1,335 1,233

Trainees 6 19 18

Apprentices 47 40 36

Interns 48 22 8

TOTaL 2,545 2,936 2,730

* Doctors Corporate (PJ) and outsourced companies are not considered in the total number of people reported. Values also disregard the Council members.

Employee integration

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HIRINg BY agE gROUP GRI 401-1

2016 2017 2018

No. Rate No. Rate No. Rate

< 30 years 259 0.10 405 0.14 214 0.08

From 30 to 50 years 207 0.08 527 0.18 151 0.06

> 50 years 7 0.00 7 0.00 5 0.00

TOTaL 473 0.19 939 0.32 370 0.14

OUR aDVISORS 2016: 16 2017: 16 2018: 15

HIRINgS BY gENDER GRI 401-1

2016 2017 2018


Men 153 0.06 305 0.10 115 0.04

Women 320 0.13 634 0.22 255 0.09

TOTaL 473 0.19 939 0.32 370 0.14

Paulista Unit ICU

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DISMISSaLS BY agE gROUPGRI 401-1

2016 2017 2018


< 30 years 192 0.08 208 0.07 204 0.07

From 30 to 50 years 168 0.07 277 0.09 296 0.11

> 50 years 25 0.01 26 0.01 66 0.02

TOTaL 385 0.15 511 0.17 566 0.21

DISMISSaLS BY gENDER GRI 401-1

2016 2017 2018


Men 127 0.05 169 0.06 217 0.08

Women 258 0.10 342 0.12 349 0.13

TOTaL 385 0.15 511 0.17 566 0.21

LaBOR ENVIRONMENT Together with the Quality area, the Su-perintendence of Human Development worked strongly in 2018 to combat violence at work, promoting training sessions that reached almost all of the Hospital's em-ployees. Issues such as moral and sexual harassment and nonviolent communication became more discussed and there was a strengthening of the Confidential Channel (read more on page 24), by which any offi-cial may report episodes of this nature.

An atmosphere research conducted during 2018 showed a favorable rate of 70%. More-over, the Hospital conducts interviews with all employees who leave the Institution in order to identify issues regarding the atmo-sphere, relationships, career planning and many other issues and actions that should be prioritized by the management.

Further, the Quality of Life Program started offering theater and music classes to inter-ested employees in 2018 – which already included ballet classes and a gym within the Institution.

Atmosphere survey raised 70% of favorability to the Institution and allowed the mapping of opportunities for improvement and management strengths

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TRaININg GRI 103-1 | 404, 103-2 | 404, 103-3 | 404, 404-1 The professional development of the Hos-pital employees is done by the Superinten-dence of Human Development, through the Corporate Education area. Many actions tak-en in the scope of Human Development in the Hospital are taken, through the Oswaldo Cruz German Hospital Institute, also to the Estivadores Hospital Complex, in Santos.

The Education and Qualification of Profes-sionals Policy and the Development and Learning Program are the norms that seek to guarantee a multi-professional team

specialized and qualified to fulfill the Institu-tion’s mission.

In the area of Corporate Education, the highlights were the restructuring of the Development and Learning Incubator and the implementation of the Learning Paths in the distance learning platform (EAD), cov-ering two axes: Institutional, which includes training for all employees; and Technical Assistance Knowledge, aimed at this public in the most diverse areas. Also highlighted was the Leadership Development train-ing, directed at the Leaders of Operational Teams. These employees, who often do not hold the position of leadership, but who are

BENEFIT PORTFOLIO GRI 401-2 The Hospital offers a series of benefits to its employees, such as food stamps, transporta-tion vouchers, life insurance, health insurance (not applicable to interns and apprentices), disability or incapacity coverage, retirement fund (only to employees who joined the pri-vate pension plan), its own restaurant, Welfare Program, educational aid in the ETES and FECS (only for CLT employees with more than 18 months in the Institution), education and day-care aid (to employees with children aged zero to six years old). Temporary staff hired by an outsourced company have, as benefits, ac-cess to the corporate restaurant, life insurance and transportation voucher.

Library

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reference for the operation in their areas of activity, were trained in technical and behavioral aspects with the objective of developing some necessary skills for the management of people and processes in the Institution .

In 2019, two more pillars of learning trails will be worked on, thus expanding the pillar of technical knowledge to other areas.

During the year, fire protection training (linked to NR23) and the new protocol for the flow of drive and service of the orange code were also the focus. The training ses-sions were linked to the individual goals of the Variable Compensation Program.

In this cycle, based on a management tool implemented during the year, it was pos-sible to standardize training information, besides inserting all the presence lists in the personnel management system, enabling

the management of data and indicators through reports. One of the possible indi-cators to be measured and monitored was hours of training related to the gender of the employee.

47hof trainingby employee in 2018

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PERFORMaNCE MaNagEMENT PROgRaM GRI 404-3

The initiative, which seeks to offer lines of understanding of the future and career development for the Institution's talents, had new methodology during the year. The results are now all inserted into a Nine Box matrix, which allows one to analyze and compare performance information for all employees. It is based on these assess-ments that the area identifies the devel-opment points to be worked on, in future training actions, in addition to mapping the most potential employees. The evaluation, now made in 180º mode, is expected to migrate to the 360º format in 2020.

The performance evaluation covers the whole institution, except apprentices (who have their own instrument by the partner who administers the contract), third parties and interns. In the case of nursery interns, the performance of Corporate Education is monitored. In 2018, the goal of engagement was to perform the performance evalua-tion with 100% adherence; at the end of the year, the percentage was close to the established target.

EMPLOYEES WHO RECEIVE PERFORMaNCE aNaLYZES BY FUNCTIONaL CaTEgORY (%) *

2018

Board of Directors 100

Management 100

Leadership/coordination 100

Technical/supervision 90

Administrative 96

Operational 100

Trainees 100

TOTaL 98

* The performance evaluation was applied in January and February 2018 and the total number of employees is related to December 2018; employees who have six months in the Institution and those who have not been retired for more than six months are eligible for performance evaluation. Apprentices and interns do not participate in performance evaluation by the annual cycle.

The disruptive business model employed by the Oswaldo Cruz Vergueiro Referenced Unit has as one of its tripods a greater control of prices. The new form of remuner-ation means that the Hospital strengthens the philosophy of cost sharing with health care providers – a no-going back path to the evolution and continuous improvement in the dialog with these important partners, key components of the supplementary healthcare system.

When a procedure ends up needing more steps and/or more resources and ends up having an unpredictable price, there are impacts for all partners involved in the pro-duction chain. Through the fee for service transition to the package model, the Oswaldo Cruz German Hospital invested in an entirely new structure of negotiation, in which its ser-vices, in the form of pre-agreed packages, are measured more in outcomes and indicators of effectiveness and quality than in volume of production . In practice, the Institution will earn more as much as it is more efficient.

Business partners GRI 102-9

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Evolution of the Oswaldo Cruz Vergueiro Referenced Unit is translated into health market challenges

Already a reality in the Oswaldo Cruz Vergueiro Referenced Unit and at Saúde Integral, the closed remuneration model is a trend in the sector and should spread throughout the private health market in the coming years. The evolution of the model is constant and is at the heart of the strategy.

The Oswaldo Cruz Vergueiro Refer-enced Unit, which specializes in mid- and high-complexity patient care, currently has 89 hospital beds, 10 ICU rooms and six operating rooms, as well as a a Diagnostic Imaging Center (CDI). When it is working with its total capacity, the unit will have 232 beds, 30 of them of ICU, as well as a surgi-cal center with 13 rooms and clinics.

Today, the model of closed prices already reaches procedures in the areas of oncology, cardiology, orthopedics, neurology, urology, bucomaxillofacial l and digestive diseases. There are about 500 established packages, with pre-defined protocols and an integrat-ed action of the multi-professional team. All assistances follow a medical standard defined from international experiences.

The main benefits of the new format are the predictability of prices and the risk shared between the Hospital and health plans, responding directly to one of the greatest challenges of contemporary health.

In 2018, the institution advanced in the construction of partnerships with large plan operators in the country, with prospects of expanding contracts over the next few years.

Oswaldo Cruz Vergueiro Referenced Unit

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Social responsibility

The performance of the Oswaldo Cruz German Hospital in the Social Responsibil-ity are, always a pillar of the Institution, is centered on two fronts. On one hand, the Program for Supporting the Institutional Development of the Unified Health System (Proadi-SUS) of the Ministry of Health, in which the Institution has been active since

2008 and develops a series of projects. On the other hand, the Oswaldo Cruz Ger-man Social Hospital Institute, which has launched the brand in the field of Bra-zilian public health thanks to the results achieved at the head of the administration of the Estivadores Hospital Complex, locat-ed in Santos (SP).

Proadi-SUS performance and management of public hospitals generate a positive impact on Brazilian healthcare

Contribution to society GRI 103-1 | 203, 103-1 | 413

With a focus on the purpose of establishing a healthcare culture focused on primary health care, the institutions linked to the Support Program for the Institutional Development of the Unified Health System (Proadi-SUS) – which encompasses several private health institutions with a reference and 21 projects in the Triennium 2018-2020 – invest in fronts such as team building, stimulating the incor-poration of technologies and processes and restructuring of public hospitals.

In the past few years years, the Oswaldo Cruz German Hospital has developed an im-portant work, through Proadi-SUS, together with a technical staff of state and municipal healthcare departments, enabling them to draw up a strategic planning and to create better management tools. In the 2015-2017 Triennium, R$ 164 million was invested by the Institution; in the 2018-2020 Triennium, it will be R$ 217 million.

INSTITUTIONaL DEVELOPMENT SUPPORT PROgRaM OF THE UNIFIED HEaLTHCaRE SYSTEM (PROaDI-SUS) GRI 413-1

The core of knowledge management is one of the bases that underpin the Social Responsibility pillar. Its role is to evaluate, monitor and interconnect all Hospital proj-ects in the area, so that they empower each other, focusing on improving the Unified Health System (SUS).

In the 2018-2020 Triennium, a project was established around one of the areas of emphasis at the Hospital, in which public healthcare centers already qualified to perform surgeries through laparoscopy were chosen to participate in bariatric surgery training. Hospital professionals visit these centers, perform a technical analysis and report to the Ministry of Health. Next, the professionals from the public hospitals go to the Oswaldo Cruz German Hospital to see how this type of surgery is done in the Institution – both from a medical point of view and from the assistance point of view.

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• DigiSUS: Plan of Action, Monitoring and Evaluation of e-Health for Brazil

• DigiSUS Infrastructure: Elaboration and Evolution of Information Resources for e-Health in Brazil

• DigiSUS Manager: Elaboration, Evolution and Governance of Information Resources for e-Health in Brazil

• Basic Attention: Training, Qualification of Pharmaceutical Assistance Services and Integration of Health Care Practices in the Healthcare team

• Safety evaluation of the use of medical equipment

• Diagnostic Evaluation of the Brasil Redes National Telehealth Program

• Evaluation of effectiveness and safety of teleappointment compared to face-to-face appointments to patients with mellitus diabetes referred from the Basic Attention to Specialized Care in SUS

• Study to evaluate Sepsis Incidence by re-sistant microorganisms (MR) to antimicro-bials in Brazilian ICUs: MR Impact Program MR Impact Program

• Deployment of video laparoscopy tech-nique in Gastroplasty procedure in Na-tional Hospitals with the 0202 and 0203 Enablement

• Strengthening of the SUS State Management

• Improvement of Patients’ Safety on a Large Scale in Brazil

• Methodology of Criteria for the Apportion-ment of Federal Resources Intended for Other Entities of the Federation

• Institutionalization of evaluation prac-tices: the strategic management of evi-dence-based health surveillance

• Qualification of Strategic Actions Manage-ment of Sanitary Surveillance in SNVS - In-tegra VISA

• Complexity of Assistance in Home Care

• Qualification in Preceptory Medical Resi-dence

• Capability and Training in Clinical Research

• Training, Communication and Development in PCDT and MHT

• Restructuring of Public Hospitals

• Development of Technology Assessment in Health – DATS

• Collaborative Network for Strengthening Municipal Management of SUS

• Assistance Project: Diagnostic and Surgical Procedures and Reference Services for Mam-mary Diagnosis (completed in 2018)

PROaDI-SUS PROJECTS WITH THE HOSPITaL PERFORMaNCE - 2018-2020 TRIENNIUM

For example, the Improving Patient Safety in Large Scale Project in Brazil, for exam-ple, has already resulted in a reduction of up to 32% in cases of UTI infection relat-ed to Ventilation Associated Pneumonia (IPCSL) and Urinary Tract Infection Asso-ciated with Vesical Catheter (ITU-AC) in

119 public hospitals covered by the project. These initiatives reinforce the presence of the German Hospital brand Oswaldo Cruz (PAV), Primary Infection of Labora-tory Blood Pressure and consolidate their connection with the development of the country's public health.

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SOCIaL RESPONSIBILITYSUSTAINABILITY REPORT 2018

Proadi-SUS Projects 2018-2020 Triennium

ESTIVaDORES HOSPITaL COMPLEX GRI 203-2 With 11,600m² of built area, the Estivador-es Hospital Complex is a general hospital with a medium complexity profile, focusing on maternal and child care, surgical, med-ical and clinical-surgical care. The unit has 223 beds with their total installed capacity. Currently, 131 beds are active – of which 67 are medical clinics, 10 are adult ICUs, 10 are neonatal intensive care units, three are sur-gical and 36 are maternity hospitals. There are five delivery rooms, pre-delivery and postpartum, two surgical centers and two obstetric operating rooms.

Since February 2017, the Oswaldo Cruz German Hospital offers its expertise in the management of resources (including hu-man resources), standardization of process-es and protocols, and quality of care. The amount received by the Oswaldo Cruz Ger-man Hospital Social Institute to manage the hospital in 2018 was R$ 68.3 million. In the

first two years of the hospital's operation, 4,415 deliveries were performed, 22,000 obstetric assistances, 424 hospitalizations in medical clinics, 308 admissions to the adult ICU and 20,800 imaging examina-tions. In 2018 alone, 19,054 appointments were carried out

The impact of the Estivadores Hospital Com-plex on the Santos public healthcare system has been relevant; as a reflex, the indicator of infant mortality in the city was affected, falling from 14 to 9 per 100,000 live births – a smaller figure than the one registered in the city of São Paulo and compared to the rate considered acceptable by the World Health Organization (WHO), which is 10.

The importance of the maternal-infant area to the Estivadores Hospital Complex in-spired a novelty launched in 2018, the Roda de Gestantes (“Pregnant women’s round”) program. During the past year, about 60 pregnant women and their companions were able to count on specialized physi-

86


cians and nurses to answer their doubts, in integration with the experience of the mothers. The program is based on the prin-ciples of the Prenatal and Birth Humaniza-tion Program, stipulated through Ministerial Ordinance 569/2000, which seeks to devel-op actions to foster, prevent and assist the health of pregnant women and newborns.

Furthermore, in December 2018, the Es-tivadores Hospital Complex formed the Technical Support Group for Childbirth and Labor, comprised of a multi-professional team, whose idea is to contribute to the best practices in assisting pregnant women, parturients, mothers and newborns during the labor, delivery and birth.

ASSISTANCES IN 2018

Ambulatory

1,139Emergency Obstetric Care

11,604Total deliveries:

2,319Joint accommodation

2,799Neonatal ICU

404

SURGERIES

Cesarean sections

856Surgeries

98

Adult ICU

295Surgical Clinic

100Medical Clinic

394

Total Number of Assistances in 2018:

19,054

INDICATORS

Roda de Gestantes

EXAMS

Laboratory Exams:

79,183Exams per Image:

17,045

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SOCIaL RESPONSIBILITYSUSTAINABILITY REPORT 2018

Environment

IMPaCT MaNagEMENT

The attentive look of hospital institutions for environmental impacts is also on the management radius of the Oswaldo Cruz German Hospital – as it happens in the presence of the theme in its materiality ma-trix (read more on page 41), which points out topics and impacts of greater relevance to the business.

Currently, the institution advances in aspects such as energy efficiency, water consumption and waste management, key issues for the daily processes of a hospital center, and bet on the greater efficiency of projects of new units and towers.

The new building of the Oswaldo Cruz Vergueiro Referenced Unit, for example, was erected based on principles of ef-ficiency in the use of natural resources, and Tower E of the Paulista Unit has since its inauguration in 2013, the certification entitled Leadership in Energy and Envi-ronmental Design (LEED) for New Con-structions, after a project analysis and audits of the Green Building Council. Solar water heating system, reuse water appli-cation and architecture oriented to the best natural lighting capture are among the environmental highlights, as well as vacancies adapted for electric and hybrid vehicles in the parking area.

SOLID WaSTE aND HOSPITaL WaSTE GRI 103-1 | 306, 103-2 | 306, 103-3 | 306, 306-2 In 2018, with the update of the health services waste legislation, the waste man-agement committee developed a great work that mobilized all assistance staff, reclassifying the infectious waste and common waste. Aware of these changes, the Institution seeks improvements in the rational use of resources, as well as ben-efits for the environment. The estimated reduction of infecting residue per month is 52 to 40 tons.

The Oswaldo Cruz German Hospital pre-sented in 2018, for the first time, in partner-ship with the company that carries out the solid waste collection, the benefits achieved with the recycling program, through data, demonstrating in a report, that the program

assists in the preservation of the environ-ment, reducing the amount of material sent to the landfill, avoiding air, soil and water pollution and reducing the exploration of natural resources.

The organization also reached this year the figure of 229 tons of recycled garbage in the Paulista and Oswaldo Cruz Vergueiro Referenced Units – which generated reve-nue. R$ 22.6k was included in the Institu-tion's cash in the form of a discount to the account for the collection and processing of common waste. The reclassification of chemical waste, as well as the improvement of selective collection and reverse logistics, are the area's priorities for the near future.

In total, waste treatment and disposal expenses added to the rates of solid waste from health services paid quarterly to the municipality totaled R$ 847k in 2018.

DISPOSaL OF HaZaRDOUS WaSTE 2016 2017 2018

Incineration (burning of mass) - tons 48.96 58.04 66.86

Landfill (after treatment) - tons 547.08 515.15 537.23

Other (lamps) - per units 3,200.00 7,130.00 14,015.00

* Data refer to the Paulista and Oswaldo Cruz Vergueiro Referenced Units.

90


DISPOSaL OF NON-HaZaRDOUS WaSTE(t)* 2016 2017 2018

Recycling 176.28 223.31 230.44

Landfill 1,064.52 1,145.29 1,078.42

Total 1,240.80 1,368.60 1,308.86

* Data refer to the Paulista and Oswaldo Cruz Vergueiro Referenced Units.

ENERgY aND WaTER EFFICIENCY GRI 103-1 | 302, 103-2 | 302, 103-3 | 302, 302-1,

103-1 | 303, 103-2 | 303, 103-3 | 303, 303-1 The reforms in the Paulista Unit and the beginning of the operation of the Oswaldo Cruz Vergueiro Referenced Unit made the organization's priority in 2018 to guaran-tee safety in water and energy supply. An

artesian well located inside the Hospital was delivered, and a power plant is expected to be ready by 2019.

Among the goals for the future are in-vestments in actions that generate more efficiency, such as the automation of air conditioners and the replacement of lamps with more modern LED versions.

FUEL CONSUMPTION FROM NON-RENEWaBLE SOURCES (gJ) * 2016 2017 2018

Channeled gas (São Paulo) 8,219.42 15,810.91 13,774.97

Diesel oil 1,079.38 1,850.48 1,111.50

Total 9,298.80 17,661.39 14,886.47

ENERgY CONSUMED (gJ)* 2016 2017 2018

Electricity 69,429.25 70,583.21 69,727.82

TOTaL CONSUMPTION (gJ) 2016 2017 2018

Fuels from non-renewable sources 9,298.80 17,661.39 14,886.47

Energy consumed 69,429.25** 70,583.21** 69,727.82

Total 78,728.05** 88,244.60** 84,558.55

* Invoices of consumption of the concessionaires and units via a converter available on the internet.** Revised and adjusted data.

WaTER WITHDRaWN BY SOURCE (M³) * 2016 2017 2018

Municipal water supply or other water supply companies

129,946.00 145,565.00 137,981.00

* Measurement of water consumption is done by means of measuring instruments of the municipality's water utility.

91

ENVIRONMENTSUSTAINABILITY REPORT 2018

AnnualGRI 102-45, 102-46, 102-48, 102-49, 102-51, 102-52, 102-53, 102-54, 102-56

The Oswaldo Cruz German Hospital disclos-es, in this Sustainability Report, another cy-cle of performance, projects, challenges and results lived by the Institution. For the year 2018, the publication is based, once again, on the guidelines of the Global Reporting Initiative (GRI), Standard version, Essential option, to communicate to its stakeholders a summary of financial and non-financial indicators for the period.

The content essentially covers the period from January 1 to December 31, 2018 and was structured based on the 2016-2020 Strategic Planning, their respective themes and management indicators and the mate-riality – list of social, economic and environ-mental issues considered more relevant by the stakeholders. GRI 102-50

Operational, financial and socio-environmen-tal indicators were defined based on these guidelines and cover all operational units directly maintained by the Hospital – which includes the Paulista Unit, the Oswaldo Cruz

Vergueiro Referenced Unit, the Campo Belo and Mooca units, and in some specific cases, the Estivadores Hospital Complex, under the management of the Oswaldo Cruz German Hospital Social Institute.

The presentation of the hospital's own data follows market references and also disclo-sure criteria based on national and inter-national protocols and standards – such as quality, safety and protocol compliance rates. The purpose of communication based on standardized instruments in the fields of sustainability and hospital management is to allow comparability and easy under-standing of the data by the different publics with which the Institution relates – patients, relatives, employees, associates, clinical staff, suppliers, health agreement operators, financial institutions, experts, public author-ities and opinion leaders, among others.

The report is available in this complete version, in print and PDF formats; in a sum-mary model, also printed and in PDF; and digital platform, bringing together some of the highlights of the year 2018. To clarify any doubts about the information present-ed in the document, please contact us at e-mail [email protected].

Report combines GRI methodology with specific health sector metrics

94


GRI content summary GRI 102-55

GRI Standard Disclosure Page/URL OmissionSustainable

Development Objectives

gENERaL DISCLOSURE

Organizational profile

gRI 102: General Disclosure 2016

102-1 Organization’s name 14

102-2 Activities, brands, products and services

14

102-3 Headquarters’ location 14

102-4 Operations location 18

102-5 Property nature and legal form

14

102-6 Markets served 18

102-7 Organization’s size 14 and 18

102-8 Information about employees and workers

73 to 75 8

102-9 Supplier chain 80 and 81

102-10 Meaningful changes in the organization and its supplier chain

17

102-11 Approach or precautionary principle

56

102-12 Externally developed initiatives 41

102-13 Participation in Associations 59

Strategy


102-14 Statement from the senior decision-maker

6 and 7

Ethics and integrity


102-16 Values, principles, standards and behavior standards

24 and 25 16

Governance


102-18 Governance structure 22, 23 and 24

95

aNNUaLSUSTAINABILITY REPORT 2018



Stakeholders’ engagement


102-40 List of stakeholder groups 43

102-41 Collective negotiation agreements

43 8

102-42 Identification and selection of stakeholders

41 and 42

102-43 Approach to stakeholder engagement

41, 42, 43 and 72

102-44 Main topics and concerns raised 41.42, 43 and 72

Report practices


102-45 Entities included in the consolidated financial statements

92 to 94

102-46 Defining report content and topic boundaries

92 to 94

102-47 List of material topics 41 and 42

102-48 Data reformulations 92 to 94

102-49 Report changes 92 to 94

102-50 Report period 94

102-51 Latest report date 2017

102-52 Report cycle 92 to 94

102-53 Contact point for questions about the report

92 to 94

102-54 Option according to GRI Standards

92 to 94

102-55 GRI Content Summary 95 to 100

102-56 External Assurance None



MaTERIaL TOPICS

Economic performance

gRI 103: Management approach 2016

103-1 Explanation of the material topic and its limits

42

103-2 Management approach and its components

46 1, 5, 8, 16

103-3 Management approach evolution 46

96




gRI 201: Economic performance in 2016

201-1 Direct economic value generated and distributed

46 to 48 2, 5, 7, 8, 9

201-3 Defined benefit plan obligations and other retirement plans

The hospital has a con-tribution agreement defined as minimum, regular or additional, according to the employee's contribu-tion. The employer's minimum contribution is 1% of the participa-tion salary limited to R$ 5,542.55 (refer-ence 2019). It is the incumbent upon the Employer to make the contributions prom-ised up to the date of the participant's eligibility to benefit or until their departure – or until their disability or death is attested.

201-4 Financial aid received from the government

The government does not directly or indirectly sponsor the Institution's operations.

Indirect economic impacts



42


86

103-3 Management approach evolution 86 and 87

gRI 203: Indirect economic impacts in 2016

203-2 Significant indirect economic impacts

86 and 87 1, 2, 3, 8, 10, 17

Fight against corruption



42


24 and 25

103-3 Evolution of the management approach

25

gRI 205: Fight against corruption in 2016

205-3 Confirmed cases of corruption and measures taken

25 16

97




Energy



42


91


91

gRI 302: Energy in 2016302-1 Energy consumption within the organization

91 7, 8, 12, 13

Water



42


91


91

gRI 303: Water in 2016 303-1 Total water withdrawal by source 91 6, 7

Effluents and waste



42


90 and 91


90 and 91

gRI 306: Effluents and waste in 2016

306-2 Waste, broken down by type and method of disposal

90 and 91 3, 6, 12

Employment



42


73 and 74


73 and 74

gRI 401: Employment in 2016

401-1 Rates of new hires and employee turnover

76 and 77 5, 8

401-2 Benefits granted to full-time employees that are not offered to temporary or part-time employees

78 8

Local communities



42


84 to 86


87

gRI 413: Local communities in 2016

413-1 Operations with implemented programs of local community engagement, impact assessment and local development

84 3, 6, 12

98




Consumers' Health and Safety



42


56


56

gRI 416: Consumers' Health and Safety in 2016

416-1 Products and services for which health and safety impacts are evaluated

56

416-2 Cases of non-compliance related to health and safety impacts of products and services

In 2018, the number of notifications decreased by 24%. There were 7,374 registered cases of non-compliance with voluntary codes related to the health and safety of products and services. For 2019, there is an ongoing task of analyzing and encouraging the reporting of near misses, strengthening proactive behavior in the early identification of risks and failures to prevent harm to patient care.

16

Marketing and labeling



42


56


56

gRI 417: Marketing and labeling in 2016

417-1 Requirements for information and labeling of products and services

Information regard-ing the outsourcing of components of products or services; substances that may have an environmental or social impact; safe use of the product or service; and safe use of the product or service are required by the organization's procedures for infor-mation and labeling of products and services.

12, 16

99




Customer’s privacy



42


24


25

gRI 418: Customer’s privacy in 2016

418-1 Proven Complaints Regarding Privacy Violation and Customer Data Loss

25 16

Socioeconomic compliance



42


24

103-3 Management approach evolution 25

gRI 419: Socioeconomic compliance2016

419-1 Non-compliance with social and economic laws and regulations

In 2018, no significant fines or penalties were received for non-compliance with social and economic laws and regulations

The indicators of the Oswaldo Cruz Vergueiro Referenced Unit and and of the Estivadores Hospital Complex were monitored after their deployment, there-fore, data prior to 2017 are not demonstrated in this report.

SUSTAINABLE DEVELOPMENT OBJECTIVES

1. Eradicating poverty

2. Zero Hunger and a Sustainable Agriculture

3. Health and well-being

4. Quality education

5. Gender equality

6. Drinking water and sanitation

7. Clean and accessible energy

8. Decent work and economic growth

9. Industry, innovation and infrastructure

10. Reducing inequalities

11. Sustainable Cities and Communities

12. Responsible consumption and production

13. Action against global climate change

14. Sea life

15. Land life

16. Peace, justice and effective institutions

17. Partnerships and means of implementation

100


CERTIFICaTIONS aND aWaRDS

2003

Level 2 ONA Certification Integrated management

Bariatric Surgery CenterCertification

Endoscopy CertificationSOBED Endoscopy

Aberje AwardPress Communication and

Relations

Aberje AwardPrinted Media

LEVE Magazine

Aberje AwardPrinted Media

LEVE Magazine

Aberje AwardDigital Media

Global HealthyWorkplace Awards

AutomationAward 2018

The Best of Dinheiro Award: best company in the country's

healthcare area


healthcare area

Temos Certification

Temos Certification

Welfare program National Award of Quality

of life

Healthcare AwardWelfare program

Level 3 ONA Certification Excellence

JCI Accreditation

JCI re-accreditation

JCI

Nourishment Service Green Kitchen Seal

Latin American Award of Excellence in Hand

Hygiene

Level 3 ONA Recertification Excellence

2009

2012

2013

Temos Certification

2013

JCI: Tower E extension evalu-ation

Endoscopy CertificationSOBED Endoscopy

2014

2016



Certification Leed Gold

2015

Recertification of the Bariatric Surgery Center

2016

2017 2018

2018

2010

Quality Management Award

2011

2005 2007 2008

Best Companies in Labor Health and Safety Award –

ANIMASEG

Elderly’s friend São Paulo Program

2017


healthcare area


healthcare area

National Award of Quality of life

Recertification of the Bariat-ric Surgery Center

Nourishment Service Green Kitchen Seal

101


Credits

DIRECTED BY

Paulo Vasconcellos BastianExecutive Superintendent

GENERAL COORDINATION

Melina Beatriz gubserMarketing and Communication Manager

SUPERVISED BY

Claudete Cardenette JensenMarketing and Communication Supervisor

EDITORIAL COORDINATION

Michelle BarretoInstitutional Communication Coordinator

Rafael PeciauskasInstitutional Communication Analyst

PRODUCTION SUPPORT

Débora guedes Fernandes SoaresMarketing analyst

Rafaela RosasInstitutional Communication Analyst

GRAPHIC AND EDITORIAL DESIGN

Sustainability Report

PHOTOS BY

Lalo de almeidaKarime XavierRoberto assemImages from the Hospital archive

PRINT

Forma Certa graphic Company

Sustainability Report 2018Oswaldo Cruz german Hospital

www.hospitaloswaldocruz.org.br

/hospitalalemaooswaldocruz /company/hospitalalemaooswaldocruz /hospitalalemaooswaldocruz

/hospitalalemao

Paulista Unit Rua Treze de Maio, 1.815 Bela Vista CEP 01327-001São Paulo - SPTel.: 11 3549 0000

Campo Belo UnitAvenida Vereador José Diniz, 3.457 SobrelojaCampo BeloCEP 04616-003São Paulo - SPTel.: 11 2344 2700

Referenced Unit Oswaldo Cruz VergueiroRua São Joaquim, 36Liberdade CEP 01508-000 São Paulo - SPTel.: 11 3549 1999

Specialized Centerin Obesity and DiabetesRua Cincinato Braga, 37 5º andarBela Vista CEP 01333-010 São Paulo - SPTel.: 11 3549 0401

SUSTAINABILITY REPORT 2018€¦ · Investments and prospects 35 Sustainability management 41 High...

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