2015 sustainability report - hospital sírio-libanês · 2016-10-10 · in 2015, we celebrated the...

2015 Sustainability Report

More knowledge for better care

OUR PURPOSE IS TO CARE FOR THE HEALTH OF EACH AND EVERY PERSON, OF SOCIETY

AND OF THE PLANET

4 MESSAGE FROM THE PRESIDENCY

6 HIGHLIGHTS OF THE YEAR

8 TIMELINE

11 PRESENTATION

14 SÍRIO-LIBANÊS HOSPITAL

18 Shared value 20 Governance and management 24 Quality management 32 Clinical governance

39 EDUCATION AND RESEARCH

53 SOCIAL RESPONSIBILITY

57 Sírio-Libanês Institute for Social Responsibility

59 RELATIONS

62 Human capital 70 Suppliers

72 ENVIRONMENTAL MANAGEMENT

75 Water consumption management

76 Energy consumption

77 Gas emissions

79 OUR FIGURES

81 ABOUT THE REPORT

82 GRI Content Summary

87 Assurance letter

90 ORGANIZATIONAL STRUCTURE

93 TECHNICAL DATA SHEET

Table of Contents

In 2015, we celebrated the strength of the Ladies’ Beneficent Society – Sírio-Libanês Hospital and its results. We experienced a challenging year with increas-ingly consolidated management and our valuable human capital, having returned to society, in the form of projects supporting the Brazilian Public Healthcare Sys-tem (SUS), R$ 108 million invested in philanthropy.

Our investment in the integration of management tools and budget provided for a systematic moni-toring of our plans and works, leading us to a good financial per-formance and sustainable growth.

Also, the continuous improve-ment of our healthcare processes ensured a qualitative leap in the services provided to patients who rely on the structure of our units in São Paulo (Bela Vista, Itaim and Jardins) and Brasília (Asa Sul and Lago Sul).

In 2015 we partially reaped the

fruit of the opening of the new towers of our Bela Vista unit. The Sírio-Libanês Hospital presently offers 451 beds. In order to pro-vide patients with greater qual-ity, safety and effectiveness, we carried out structural changes towards a more integrated and intelligent work model. A com-prehensive, efficiency-based plan guided our way throughout 2015.

With new organization models and ongoing investments in the qualification of our teams, we achieved significantly superior standards. Throughout the year, we were granted five certifica-tions: CARF (Commission on Ac-creditation of Rehabilitation Fa-cilities); ISO 14001 (environmental management); OHSAS 18001 (workers’ health and safety man-agement); “Selo Amigo do idoso” [friend of the elderly seal] (São Paulo State Government); and the Accreditation Canada (Cana-dian Council on Health Services Accreditation) in the “Diamond” category.

The use of new technologies is part of our pioneering nature, which is one of the pillars of our evolution. Accordingly, our units have reduced paper consumption by using the Patient’s Electronic Medical Records (PEP). In addi-tion to this system, on-line tools connect and provide transparency and safety to the information ad-dressed to both the medical staff (Physician’s Portal) and the pa-tients (Patient’s Portal).

With regard to innovations that improve our workplace and influ-ence our quality indicators, we have implemented the critical findings’ notice for imaging exams – a direct channel for communica-tion with the requesting physician that warns about critical diagnosis and ensures continuity of the pa-tient’s care.

In order to strengthen our health-care network providing assistance to our employees and their de-pendents, we made adjustments to the health plan and improved

Message from the presidency

Guided by efficiency, in 2015 we carried out structural changes to integrate our teams, improve our intelligence, and enhance the

quality of our healthcare services.


the Caring for Care Givers pro-gram, which currently offers a multi-professional team dedi-cated to primary care. Together, these moves have taken us to the institution we have longed for: a healthy, integrated and productive environment in permanent evolu-tion.

We also present the positive re-sults of the Sírio-Libanês Educa-tion and Research Institute (IEP), an important professional edu-cation center that produces and disseminates knowledge, operat-ing in close partnership with the healthcare areas to develop even more efficient patient care strate-gies.

We highlight the qualification ac-tivities conducted outside the in-stitution in all regions of Brazil. In 2014, we welcomed 24 thousand participants in our educational ac-tions - of which 16 thousand were professionals of SUS units from all Brazilian regions, representing a huge potential for transformation and improvement of our society.

Our philanthropic actions includ-ed a new cycle of participation in the SUS Institutional Development Support Program (Proadi/SUS) in 2015, through which we prepare and implement projects. From 2009 to 2014, some 20 thousand professionals were qualified each year across more than 370 health regions in Brazil, spreading knowl-edge and the access to the best healthcare practices and process-es.

The Sírio-Libanês Institute for So-cial Responsibility also contrib-utes to our philanthropic mission by managing public health units in partnership with municipal and

state governments. In 2015, the institute faced challenges due to adjustments in public funds, as a result of lower tax collection. Difficulties were overcome with improved management of these units, generating quality and safe-ty for SUS users.

Believing that our work is in line with the expectations and de-mands of society, we will continue to improve our actions. In 2106, we will go on with our intelligent and balanced management, which is grounded on the tripod formed by the excellence of our actions, the demand for our services, and the efficiency of our operations. We will create the conditions re-quired to go through the year peacefully and maintain sustain-able growth in all aspects of our work.

Enjoy your reading!

Marta Kehdi Schahin, President of the Ladies’ Beneficent Society

Paulo Chapchap, Chief Executive Officer (CEO)

(G4-1)

24 THOUSAND PARTICIPANTS

IN EDUCATIONAL ACTIONS, OF WHICH 16 THOUSAND WERE

PROFESSIONALS OF THE PUBLIC HEALTHCARE

SYSTEM IN BRAZIL

72015 SuStainability RepoRt

procedure in the country us-ing the valve-in-valve method through surgical incision, with simultaneous repair of the mitral valve. This approach is a new advance in heart surgery, po-tentially offering greater speed and safety, with lower morbidity and mortality rates.

•In partnership with everis, a business and technology con-sultancy firm, and through its Foundation, the institution held

the first edition of the “Em-preenda Saúde” Award, which is intended to encourage inno-vation, entrepreneurship and social development. The winner of the award, Paula Renata Cer-deira Gomez, presented a proj-ect that contributes for the early detection of epileptic seizures.

•The application Patient’s Portal, developed by our information technology team, won the Oi Tela Viva Móvel [Oi Mobile Live Screen] Award in the “health and well-being” category, as well as the 15th ABT Award, granted by the Brazilian Insti-tute of Relationship Marketing (IBMR), in the product innova-tion and processes group.

•The article published in the Você S/A magazine in March 2015 highlighted the actions taken by the Sírio-Libanês Hos-pital to save and make good use of water.

Highlights of the year

National and international certifications and awards, advances

and innovations in healthcare

•One of the new towers of the Bela Vista hospital complex re-ceived one of Brazil’s largest vertical gardens, with 1,000 m2, 27-m in height, and 80 thousand plants of 42 species. It is part of a project to implement vertical gardens in 20 buildings of the Minhocão region, downtown São Paulo.

•A team of physicians of the Car-diology Center conducted the first aortic valve replacement


•IEP ranked first in the Social Application of Polycom Cus-tomer Success Award category (CSA), for its use of the Poly-com RealPresence video tech-nology in education programs for healthcare professionals in Brazil.

•The Sírio-Libanês Hospital sponsored the HSM Expoman-agement 2015, a major manage-ment event in Latin America, through activities and lectures about management, ethics and innovation.

•The Philanthropy Outpatient unit has completed ten years of services to SUS patients and a new ultrasound unit was opened.

•Opening of the Multi-profes-sional Qualification Center, a space dedicated to improve-ment and updating of teams that work with patient care.

•Participation in the 22nd Hospi-talar, the biggest event of the sector in the Americas. Our in-stitution presented consulting programs, and healthcare and people management, in addi-tion to educational and research projects.

•Participation in MEDINFO 2015, the world’s most important event on health informatics, or-ganized by the Brazilian Society of Health Informatics. The event received over 1 thousand per-sons from 67 countries.

•Highlight in the Guia Exame de Sustentabilidade [Exame mag-azine sustainability guide] in the healthcare services segment

for the second consecutive year.

•For the second consecutive year, we were elected as the most prestigious healthcare brand in the survey released by Época Negócios magazine.

•IT Mídia publishing group select-ed our institution to integrate the ranking of The Top 100 Most Innovative Companies in IT.

•The Social Responsibility Seal of the Settaport Foundation recog-nized our efforts to preserve the environment and improve the quality of life of society.


1931 Beginning of construction of the original building, currently named Building A, located in Bela Vista district, downtown São Paulo.

1943 Occupation of the building by the Preparatory School of Cadets of the Brazilian Army; the opening of the hospital was temporarily postponed

1959 The building was returned to the Ladies’ Beneficent Society

1961 The first surgery was successfully conducted (a gastrectomy led by Dr. Daher Elias Cutait)

TimelineIn 2015, the Sírio-Libanês Hospital

completed 94 years of contribution to the development of health in Brazil.

1921ADMA JAFET FOUNDED THE LADIES’ BENEFICENT SOCIETy


1965 Official opening, on August 15, under the clinical guidance of Dr. Daher Cutait, having Violeta Jafet as the president of the Ladies’ Beneficent Society

1970Opening of Building B

1971Opening of the first Intensive Care Unit (ICU) in Brazil, and of the Radiotherapy Service, with the first linear accelerator of pho-tons and electrons in Latin Amer-ica.

1980Creation of the Volunteer Service, which contributes to the human-ization of healthcare services.

1992Opening of Building C, a 40 thou-sand-m2 building with 20 floors that include inpatient units, a di-agnostic center, helipad, restau-rant and other facilities

1993The institution was granted the ti-tle of hospital school by the min-istries of Education and Culture; beginning of the Medical Resi-dency program

1995Foundation of the Organs and Tissue Transplantation Unit, spe-cializing in kidney, liver, bone mar-row, cornea and heart surgeries.

1997International scientific coop-eration partnership agreements signed with Harvard Medical In-ternational and Memorial Sloan-Kettering Cancer Center, both in the United States

1998Creation of the oncology center

1999 Development of the first telemed-icine program in Brazil

2000 First robot-guided telesurgery in the southern hemisphere: a pa-tient underwent surgery at the Sírio-Libanês Hospital in a proce-dure carried out jointly with Drs. Anuar Ibrahim Mitre and Louis Kavoussi, from Baltimore, in the United States.

2003 Our hospital was the first in Latin America to offer PET/CT (posi-tron emissions tomography) ex-ams; opening of the building of the Education and Research Insti-tute (IEP), formerly named CEPE; agreement with the São Paulo City Administration on the provi-sion of healthcare services to SUS patients, and support services re-garding building and IT mainte-nance for the primary healthcare units (UBS) located in the Sé dis-trict, downtown São Paulo

1978FOUNDATION OF THE STUDIES AND RESEARCH CENTER (CEPE), WITH THE PURPOSE OF INCORPORATING RESEARCH INTO HOSPITAL ROUTINES


2004 Launch of the preventive medi-cine program; setup of the check-up and rehabilitation centers, and of the mastology unit.

2005 Certification of IEP by the Minis-try of Education: the institute was accredited to offer graduate de-gree programs in the healthcare area; first 64C tomography for heart diagnosis was installed in Brazil

2007 Certification by the Joint Com-mission International (JCI), the most important international quality seal for healthcare ser-vices.

2008 First surgery using the da Vinci S robot; foundation of the Sírio-Libanês Institute for Social Re-sponsibility, a social organization that dedicates to the manage-ment of public health services; signing of the agreement with the Ministry of Health on the deploy-ment of new philanthropy proj-ects focused on the SUS Develop-ment Support Program (Proadi/SUS)

2009 Revamping of the Sírio-Libanês brand, aiming at synthesizing the institution’s core values; expan-sion of the Emergency Service Unit; beginning of construction of the new towers of the Bela Vista unit.

2010 Opening of the Itaim Unit, in São Paulo; opening of the Umbilical Cord and Placenta Blood Bank, which gives hope of healing to patients with different types of blood diseases.

2011 Opening of the Brasília – Asa Sul Unit, the first outside São Paulo, specializing in oncology, and the Jardins Unit, in São Paulo.

2012 Opening of the Advanced Cardiac Insufficiency Unit (UAIC), which is part of the cardiology center and provides assistance to our pa-tients as well as SUS patients.

2013 Opening of the Radiotherapy ser-vice at the Brasília - Asa Sul Unit, expanding the assistance provid-ed to patients with cancer.

2014 Opening of the Brasília - Lago Sul Unit, the second unit in the fed-eral capital, also specializing in oncology. The hospital also hosts Siemens’ first International Center of Reference in Cardiovascular Imaging in the Americas.

2015 On April 23, the hospital opens its two new towers in Bela Vista, which comply with sustainable building standards.


PresentationFor the seventh consecutive year, the Sírio-Libanês Hospital presents its performance, strategic information and results, seeking

transparency for its stakeholders and more sustainable practices

The seventh Sustainability Report of the Ladies’ Beneficent Society – Sírio-Libanês Hospital was pre-pared to account for the institu-tion’s performance in 2015. Based on our pillars – healthcare, educa-tion, research, and social respon-sibility –, it describes the priority themes guiding our activities and impacting the institution both in-ternally and externally. (see chart on the next page).

The themes presented are the same defined in our last review, conducted in 20141, thus ensur-ing continuity and consistency of the activities developed so far. In 2016, the material themes relating to the hospital will be reviewed.

With the purpose of clarifying the information provided, the chap-

1 The priority given to the themes resulted from a panel carried out in 2014 with participation of mem-bers of the surrounding community and suppliers; the answers given to the on-line questionnaire sent to managers, medical staff, employees, third parties and patients; as well as interviews with specialists.

ters of this Sustainability Report include icons with links to each of the 13 material themes (see below the full list of themes and their respective icons). Accord-ingly, readers are able to under-stand our integrated approach to operations and management of our impact.

This document follows the Glob-al Reporting Initiative (GRI) G4 guidelines, the main reference worldwide for sustainability re-ports. For more details, see About the Report, which describes all in-dicators reported by the Ladies’ Beneficent Society – Sírio-Libanês Hospital.

(G4-18, G4-24, G4-25)


(G4-19, G4-20, G4-21, G4-27)

Material theme Stakeholders impacted (I and O*) Aspect and indicator In the

report

Fo

cus

on

pat

ient

s Safety and quality of services

Employees, physicians, patients (I), donors/ investors (O)

Patient health and safety: G4-PR1, G4-PR2

Labeling of products and services: GR-PR5

Pages 24, 25, 32, 33, 59

Transparency in healthcare – Patient empowerment

Employees, physicians, patients (I), donors/investors (O)

Patient health and safety G4-PR1

Labelling of products and services: GR-PR5

Pages 24, 25, 32, 33, 59

Env

iro

nmen

tal F

ocu

s

Maintenance and expansion of sustainable facilities

Associates (I), donors/investors and suppliers (O)

Energy: G4-EN3, G4-EN4, G4-EN5, G4-EN6

Water: G4-EN8, G4-EN9, G4-EN10

Emissions: G4-EN15, G4-EN16, G4-EN18

Effluents and waste: G4- EN22

Pages 73, 74, 75

Hospital waste management

Associates (I), donors/investors, associates, suppliers (O)

Effluents and waste: G4-EN23, G4-EN25 Page 72

Responsible use of water, energy efficiency and clean energy generation

Associates (I), donors/investors, suppliers (O)

Energy: G4-EN3, G4-EN4, G4-EN5, G4-EN6

Water: G4-EN8, G4-EN9, G4-EN10

Emissions: G4-EN15, G4-EN16, G4-EN18

Pages 73, 74, 75

*I = inside the institution. O= outside the institution


Material theme Stakeholders impacted (I and O*) Aspect and indicator In the

report

Fo

cus

one

mp

loye

es a

nd m

edic

al s

taff

Employee retention, turnover reduction, organizational climate and career plan

Employees, physicians and patients (I)

Employment: G4-LA1, G4-LA2, G4-LA3

Pages 61, 62, 64

Employee health and safety


Occupational health and safety: G4-LA5, G4-LA6, G4-LA7

Page 67

Professional development for physicians and employees


Training and education: G4-LA9, G4-LA10, G4-LA11

Pages 65, 66

Fo

cus

on

gov

erna

nce

Transparency in accountability and anti-corruption actions

Associates (I), donors/investors, suppliers and government (O)

Economic performance: G4-EC4 Pages 72

Financial health of the business

Donors/investors, suppliers and government (O)

Economic performance: G4-EC1 Page 78

Fighting all forms of discrimination

Employees (I), local community and society (O)

Human rights: G4-HR2, G4-HR3 Page 59

Fo

cus

on

soci

ety

Own projects and initiatives to assist local communities

Local community and society (O) Human rights: G4-SO2 Page 86

Healthcare professionals’ education, research studies and partnership to improve SUS

Local community and society (O)

Indirect economic impacts: G4-EC7, G4-EC8 Page 37


Headquartered in São Paulo, the Sírio-Libanês Hospital is an inter-national benchmark in healthcare, with a long track record of patient care, and actions targeted to the Brazilian society and innovative education and research. The insti-tution offers preventive medicine programs, urgent and emergency medical treatment, highly complex therapeutic inpatient care, and re-habilitation services, among other. (G4-3)

The hospital’s supporting entity, the Ladies’ Beneficent Society, is a not-for-profit institution founded in 1921 by a group of women from the Syr-ian and Lebanese communities. The hospital was officially opened in 1965, and its work is grounded on a human approach to healthcare, on pioneering and on excellence, an essence that is still present in the institution’s operation. (G4-7)

Three units in São Paulo and two in Brasília are part of a healthcare network that assists thousands of patients each year. Our structure has 451 beds, and this figure in-creased after the opening of the new towers. (G4-13)

In addition to the quality of health-care services, which are certified by national and international seals, our social responsibility efforts, and pioneering in education and research contribute for a better quality of life of an increasing num-ber of Brazilians. This is due to the cooperation established between the Sírio-Libanês Hospital and the Brazilian Public Healthcare System (SUS), through the development of philanthropic projects intended for dissemination of knowledge in health. Our educational programs qualified 16 thousand SUS profes-sionals in 2015.

As a core agent in some of these projects, the Sírio-Libanês Educa-tion and Research Institute (IEP) registered on its education portal, which concentrates a greater por-tion of the institute’s activities, 97 thousand students and professors. The professional development of physicians, healthcare profession-als and managers – all of whom are multipliers of good healthcare practices – impacts the expansion of knowledge, and humanized and safe patient care.

Sírio-Libanês Hospital

As an international reference center in healthcare, the institution offers 451 beds and assists thousands of patients per year

in São Paulo and Brasília (GR-4, G4-56)

OUR PURPOSECARING FOR THE HEALTH

OF EACH AND EVERY PERSON, OF SOCIETY AND

OF THE PLANET

COMMITMENTMORE KNOWLEDGE FOR

BETTER CARE


MissionThe Ladies’ Beneficent Society – Sírio-Libanês Hospital is a Brazilian philanthropy institution that develops integrated social assistance, healthcare, education and research actions.

VisionTo be recognized internationally for its excellence, leadership and pioneering in healthcare and generation of knowledge with social and environmental responsibility, and self-sustainability, so as to attract and retain talented people.

Values•Humanwarmth

•Excellence

•Pioneering

•Knowledge

•Philanthropy

451 OPERATING BEDS (OF WHICH 79 MADE AVAILABLE IN 2014

AND 2015)

R$ 108 MILLION

ALLOCATED TO SOCIAL RESPONSIBILITY PROJECTS

IN 2015

18 SÍRIO-LIBANÊS HOSPITAL18 HOSPITAL SÍRIO-LIBANÊS

5,975 EMPLOYEES

Units and operation (G4-6, G4-8)

Bela Vista, São Paulo

Inpatient unitsEmergency Service UnitDiagnostic CenterSurgical centerBlood bankUmbilical Cord and Placenta Blood BankPathological Anatomy laboratoryDay hospitalSpecialty centersAdvanced Medicine UnitsEducation and researchSocial responsibility

Itaim, São Paulo

Diagnostic Center Clinical oncology Human Reproduction Center Surgical center / Day hospital Health Monitoring and Check-up Center

Jardins, São Paulo

Diagnostic CenterGenetics counselingIntegrated bone health centerOutpatient medical appointments

Asa Sul, Brasília

Outpatient medical appointments - oncologyChemotherapyRadiotherapy

Lago Sul, Brasília

Outpatient medical appointments - oncology Chemotherapy

155,000 M² OF BUILT AREA IN THE BELA

VISTA COMPLEX

MORE THAN

60 SPECIALTIES 5

UNITS, OF WHICH THREE IN SÃO PAULO (BELA VISTA, ITAIM AND JARDINS), AND

TWO IN BRASÍLIA (ASA SUL AND LAGO SUL)4,100

PHYSICIANS (HIRED UNDER THE LABOR CODE

[CLT], OUTSOURCED, AND PROFESSIONALS

ACCREDITED TO WORK IN THE INSTITUTION)

STRUCTURE (G4-9, G4-10)


Healthcare, education, research and social responsibility. Togeth-er, these pillars converge to the focus of our essence: healthcare. We take care of our patients’ health through integrated ser-vices provided by profession-als working in different areas of knowledge and whose prac-tices are subject to constant im-provement. This provides greater quality and safety, reduces the chances of failure, and provides an effective contribution for the well-being of patients.

For the sake of continuously im-proving our healthcare services, we adopt new technologies. Ad-ditionally, we promote access to cutting-edge medicine to a grow-ing number of persons through the Sírio-Libanês Education and Research Institute (IEP). The in-stitute, which is a center of gen-eration and dissemination of knowledge in healthcare, offers residency programs, lato sensu and stricto sensu graduate pro-grams, courses, conferences and research projects. Part of these activities is addressed to pro-fessionals in the public health-care system (SUS), which brings positive results for the organiza-tion and for the Brazilian public healthcare system.

In addition to the educational projects developed by IEP, other valuable initiatives for society in-clude the improvement in mecha-nisms for management of public health units (a work performed by the Sírio-Libanês Institute for

Shared Value

CO

MM

ITM

ENT TO THE GENERATION OF VALUE FOR SOCIETy

CARING

AssistanceEducation

and research

Social responsibility

Social Responsibility since 2008), and the improvement in the qual-ity of life of the local community of Bela Vista district (with actions in areas such as health, well-be-ing, income generation and pro-fessional improvement). (G4-26).


Results of the Sírio-Libanês Education and Research Institute (IEP)•24 thousand participants in the

activities offered

•16 residencies in health areas, totaling 270 residents

•150 scientific articles published in Brazilian and international sci-entific journals

•97 thousand students and pro-fessors registered on IEP’s edu-cation portal.

•105 thousand posts in on-line discussion forums.

Social responsibility results•29 thousand exams performed

by the Philanthropy Outpatient Unit.

•270 volunteers at the Bela Vista, Itaim and Brasília (Asa Sul and Lago sul) units and Menino Je-sus Municipal Children’s Hospital

•5,562 people assisted in the Pe-diatrics Specialties Unit

•1,700 participants in the ac-tivities of the Abrace seu Bairro”[Embrace your District] program.

Social indicators•The ombudsman registered

9,959 complaints and 9,825 commendations

•The hospital’s recommendation index was 86 points, against 87 in 2014

•The organization has 3,763 fe-male employees. Since 2014, 70% of management positions are held by women.

•Investments in training programs amounted to R$ 5 million, the same amount invested in 2014.

•197 thousand training hours were dedicated to the employ-ees in all units

•276 scholarships were grant-ed aiming at the professional qualification of the employees (GR-57)

Indicator 2014 2015

Waste generated per day 8.6 t 9.4 t

Recycled waste 276 t 341 t

CO2 emissions 11,169 t 9,546 t

Water consumption (Sabesp and Caesb*, artesian wells and water trucks)

292 thousand m3 251 thousand m3

Natural gas consumption 297 thousand m3 299 thousand m3

Energy purchased (AES, in São Paulo/CEB, in Brasília) 35 million kWh 37 million kWh

Diesel oil consumption 22 thousand liters 307 thousand liters* In São Paulo and Brasília, respectively.

2015 Results (G4-26)

Environmental indicators


In 2015, dialogue, transparency and good management practices continued to be a governance priority, ensuring decisions in accordance with the mission, vi-sion and values of the organiza-tion. Governance maturity was a fundamental aspect. The insti-tution used instruments such as the Integra [integrate] program (strategic planning set up based on the Balanced Scorecard – BSC methodology), budget implemen-tation, and corporate communica-tion to achieve good results and risk management efficiency.

Due to Brazil’s economic situa-tion, the actions scheduled had to be reviewed. Accordingly, the institution reassessed the scenar-ios, redefined its positioning, and adjusted its strategy for the next two years.

Another important change took place in the Ladies’ Executive Committee. The guidelines for the new management period from 2015 to 2018 now include monitoring of strategic priorities. Based on this vision, three new groups were set up with the fol-lowing purposes:

•Audit Committee: to improve risk mitigation and meet com-pliance rules

•Productivity Committee: to gen-erate greater efficiency in the institution’s activities and pro-cesses

•Strategy and Finance Commit-tee: to ensure greater economic balance.

Executive Offices, Councils and Committees

The institution’s membership structure consists of members who undertake different func-tions within its governance team. These executive bodies (whose members do not receive compen-sation) are as follows: the Govern-ing Council, the Ladies’ Executive Committee, the Board of Direc-tors and the Fiscal Council. They help corporate governance en-sure quality, safety and efficiency in healthcare and administrative processes.

The most important group is the Governing Council, which is elect-ed by the members and made

Governance and management

(G4-26, G4-34)

up only of women. This council elects 16 representatives to the Ladies’ Executive Committee, which is responsible for appoint-ing the members of the Board of Directors.

With 12 members, the Board of Directors is the highest gover-nance executive body. It consists of four members of the Ladies’ Executive Committee, four busi-nesspersons with administrative and/or hospital management experience, and four physicians from the hospital’s medical staff. This composition provides the balance required for all decision-making processes. The Board of Directors appoints the Chief Ex-ecutive Officer (CEO), who de-cides on the composition of the management structure, or the so-called “senior management.” (GR-7)


GOVERNANCE STRUCTURE

IEP Education and Research Council

Governing Council

Ladies’ Executive Committee

Board of DirectorsFiscal Council

Strategy Management

Marketing and Corporate Communication Management

Institutional Relations Management

Corporate Strategy Superintendence

Corporate Superintendence

Engineering and Building Superin-

tendence

Philanthropy Superintendence

New Businesses and Pharmacy

Superintendence

Education Superintendence

Research Superintendence

Controllership and Finance

Superintendence

Logistics Superintendence

Commercial Superintendence

People Management and Quality

Superintendence

Services and Operations

Superintendence

Technical-Hospital

Superintendence

Advisory

Inpatients Superintendence

Information Technology

Superintendence

Commissions

Clinical Board

Research Ethics Committee

Clinical Management Advisory Committee

Medical Ethics Committee

Accreditation Committee

Oncology and Itaim Unit Management

Jardins Unit Management

Brasília Unit Management

Ombudsman (former Customer Service)


Strategy

Our strategic planning, the so-called Integra, has been in place since 2013. Twice a year, it is re-viewed by the Strategic Intelli-gence Forum (members of the executive committee, the Ladies’ Executive Committee and the Board of Directors, in addition to guest members, such as employ-ees and external stakeholders).

The strategic management model puts together the initiatives that must be developed aiming at quality growth and sustainable development. Major challenges are understood by means of the bottom-up strategic map (see page 23), which comprises four perspectives: people, internal processes, market and sustain-ability. For each perspective, a theme is defined and managed through specific indicators that enable a systematic evaluation of the development phase.

Another significant aspect that guides the processes, activities and services of the Sírio-Libanês

Hospital is the Health, Safety, and Environment Policy, which is dis-seminated across and used by all units. The policy seeks to:

•Contribute to people’s health and quality of life;

•Preserve the environment and prevent pollution;

•Prevent employees’ injuries and illnesses;

•Contribute to sustainable devel-opment, and share knowledge by influencing partners, suppli-ers and the community towards good practices in health, safety and the environment;

•Comply with applicable legisla-tion and with the institutional code of conduct, and other re-quirements issued by the orga-nization;

•Commit to continuous improve-ment of the management sys-tem.

COMPOSITION OF THE LADIES’ EXECUTIVE

COMMITTEE

Made up of 16 members, the La-dies’ Executive Committee relies on the concepts and values clai-med by society, making them pre-sent in the institution’s daily rou-tine. The Ladies also participate in strategic planning and budget discussions, as well as in the esta-blishment of the internal regula-tions, among other activities.


PEOPLE

Improve alliance with medical staff Develop people Attract and retain

talented persons

Pillars

Minimize the operation’s environmental impact

Be relevant for the improvement of the Brazilian

Public Healthcare System (SUS)

Generate knowledge and develop healthcare

professionals

Excellence Growth

Ensure quality, safety and efficiency for assistance and

administrative processes

Strengthen the brand as a reference for models of social

responsibility, healthcare, education and research

Rationalize costs

Innovate in processes and technologies

Increase the customer base

Strengthen relationships with health insurance providers,

corporate clients and private customers

capacity

scale

Expand the operations and be effective to generate new

businesses

MARKET

SUSTAINABILITY

Values

•Humanwarmth

•Excellence

•Pioneering

•Knowledge

•Philanthropy

Ensure the institution’s perpetuity and social

responsibilityIncrease revenues

INTERNAL PROCESSES


Each year, the Sírio-Libanês Hos-pital seeks to improve the level of quality of its healthcare, adminis-trative or support services and ac-tivities. Its quality standards and processes seek to control, over-see and continuously improve the assistance provided. To this end, the Quality area carries out some initiatives, such as internal audits with an educational bias.

The quality management objec-tives are as follows:

•Monitor risks to the safety of patients, their relatives and the staff

•Implement continuously im-provement practices

•Assess the effectiveness of im-provements obtained through objective evidences, such as in-dicators and on-site audits

•Ensure mapping, modeling and management of healthcare and administrative processes based on best practices

•Disseminate the culture of im-provement, continuous improve-ment and organizational learning.

Quality management system

In 2015, the Sírio-Libanês Hospi-tal quality management recorded advances regarding the engage-ment of healthcare teams. The Gestão à Vista [Management at Sight] board, which enables daily, weekly and monthly monitoring of indicators regarding healthcare quality and goals, is displayed at the units, and was reviewed so as to improve information readabil-ity and understanding. In order to boost the results, the Executive Committee now visits the units on a regular basis. The purpose of this initiative is to promote the interaction between superinten-dents and the teams, thus fos-tering a discussion about the in-dicators and important decisions towards improving the healthcare provided.

In 2015, we expanded the moni-toring of these quality and safe-ty standards as a result of our accreditation by the Canadian Council on Health Services, which established new targets and in-dicators. The current standards and their objectives are as follows (G4-15):

1. Safety culture Create a safety culture inside the organization

2. Identification of patients Identify patients correctly

3. Effective communication Improve the effectiveness and coordination of communication among the employees

4. Medication safety Ensure safety use of medications

5. Safe surgeriesEstablish processes to ensure that the correct surgeries and inva-sive procedures are performed in the right patients and at the right places

6. Prevention and control of infectionsReduce the risk of infections asso-ciated with the healthcare routines

7. Work environmentCreate a physical environment that may contribute for safe pro-vision of services

8. Risk assessment Identify safety risks that are inher-ent to the population assisted.

Quality management

(G4-14, PR1, PR2)


CLIENT/PATIENT

CLIENT/PATIENT

STRATEGy

PROVISION OF SERVICES

RESOURCE MANAGEMENT

CRITICAL MEASUREMENT AND ANALYSIS

MANAGEMENT RESPONSIBILITY

IMPROVEMENT

EXCELLENCE

ADMISSION

Expectations and requirements

Perceived satisfaction

DISCHARGE

Indicators

Infrastructure

Quality standards

(certifications)

Process management

Standardiza-tion of forms

Communi-cation/cam-

paigns

Institutional safety

Audits Institutional documentation

Action plans and projects

Education

CONTINUOUS IMPROVEMENT

CONTINUOUS IMPROVEMENT

QUALITy MANAGEMENT SySTEM

International patient safety targets

The Joint Commission International (JCI), in partnership with the World Health Organization (WHO), es-tablished six international goals for patient safety, with the aim of fostering specific improvements in high-risk care situations.These targets are adopted by in-stitutions worldwide, in order to provide increasingly improved as-sistance. The Sírio-Libanês Hospital monitors the indicators relating to these goals. The results achieved are described below:

Transparency in quality management

In order to consolidate its commit-ment to quality and safety, engage-ment of patients, and transparency of results, the hospital publishes on its website the indicators of fulfillment of targets relating to international standards, which are previously audited by our external consultants. Data are updated on a quarterly basis, after analysis and discussion of the results with the teams responsible for the indica-tors. (G4-26, G4-PR2)


1. Correct identification of patientsThe correct identification of pa-tients is essential for healthcare safety. This action is the starting point for the proper completion of several safety phases. It entails the correct identification of the patient as the person to whom the service is addressed (medica-tions, blood or blood products, tests, surgeries and treatments).

Actions taken The identification of patients con-sists of two different information: full name and number of medical records/service, which are record-ed in barcode format and used by the professionals to identify the patient before each healthcare action.

ResultsThe institution monitors the triple check indicator, which consists of the verification, through elec-tronic reading, of the medication prescribed by the physician; the right patient, according to the identification; and the identifica-tion of the professional involved.

2. Effective communicationHealthcare safety depends on the communication among the pro-fessionals and many areas. This communication must be timely, accurate, comprehensive, clear, and understood by everyone. Ef-fective communication at health-care institutions reduces failures and improves the safety of pa-tients.

Actions takenCommunication is a key process in shift handovers, transfer of pa-tients to/from internal or exter-nal units, emergency situations, and registrations in the patient’s medical records. The institution’s routine includes an integration moment called “pit-stop,” during which professionals from differ-ent teams discuss healthcare and operational actions, aiming at im-proving patient’s care and safety.

Additionally, the patient’s infor-mation is registered in the medi-cal records, which is a legal docu-ment containing all information about the healthcare process,

from admission through to dis-charge. It is filled out by all pro-fessionals involved in the process.

The institution carries out actions to encourage the correct comple-tion of the documents comprising the medical records. The adhe-sion of professionals is regularly assessed by the Medical Records Committee, which is a group of-ficially appointed for this activity.

3. Safe use of medicationsThe institution’s program seeks to avoid failures in the administra-tion of medications by means of a five-item safety check: patient, medication, dose, route of admin-istration and time.

Actions taken The use of medications in the in-stitution is an electronic process. Barriers were developed in order to ensure process quality, from the physician’s prescription until the administration of medications. The identification of patients – through a barcode wristband – is crucial. Patients are also instruct-ed to hand over to the nursing staff any medications they may have brought.

ResultsThe institution monitors any evi-dence of failure in the medication administration process. A target of 2.0 was defined for each 1,000 patients-day, considering that the patient’s length of stay in the hos-pital determines the risk.

1. Rate of triple check in the administration of medications at the Sírio-Libanês Hospital compared to the institution’s target

4th

90%89%

QUARTER

Our results Our target

2014

90% 89% 90% 90%

1st 2nd 3rd 4th

2015

The greater, the better


4. Safe surgeriesThis concept involves measures to reduce the risk of adverse events (which result in loss for the patient) that may occur before, during or af-ter surgeries. Checking of essential items in the surgery process seeks to ensure that assistance are provided as planned: patient, procedure, later-ality (the side of the body to be op-erated on), positioning and appropri-ate equipment.

Actions takenThe institution uses this model, working with well defined protocols that count on the involvement of the whole multiprofessional team.

ResultsThe process is monitored through laterality marking, an international practice used in surgeries and other invasive procedures involving the se-lection of one side of the body - for example, right or left arm.

The indicator takes into account the number of patients that arrive to the surgical center with the correct lat-erality marks.

3. Density of failures in the medication process of the Sírio-

Libanês Hospital compared to the institution’s target

1.83

2

QUARTER


2014

2.48 1.59 1.73 2.36

2015

The lower, the better

5. Prevention against infection riskHealthcare-associated infections (HAI) result from procedures re-quired for monitoring and treat-ing patients in hospitals, outpa-tient units, diagnostic center, or even at home (home care). HAI diagnosis is based on criteria set forth by national and foreign health agencies. HAI monitor-ing enables improvement of the healthcare processes, as well as reduction of infection risks.

Actions takenCleaning hands is an essential procedure for patients’ safety. Our healthcare routines follow the recommendations issued by the WHO, according to which health professionals must clean their hands in five different moments, including before and after any contact with the patient.

Additionally, the hospital follows good international practices, holds training and refresher pro-grams addressed to the profes-

4. Rate of patients with laterality marks made before arrival at the surgical center of the Sírio-Libanês Hospital, compared to the target set by the Best Practices Program of the Brazilian

National Association of Private Hospitals (ANAHP)

sionals, and uses high-quality products.

ResultsHAI that are systematically moni-tored by the institution include blood stream infections (BSI) as-sociated with the use of central venous catheter (CVC) – which occur when bacteria or fungi reach the blood through this equipment - and those that take place after the surgery, affect-ing the part of the body that has been operated on.

In the first case, we consider the number of episodes of blood stream infections (BSI) associ-ated with the use of central ve-nous catheter (CVC) in patients at critical units. In the second case, we analyze the number of infec-tion episodes that take place at the surgery site after the surgical procedure.

100%100%

QUARTER


Best Practices Program of ANAHP

2014

100% 100% 100% 100%

2015

The greater, the better

96.8%

4th 1st 2nd 3rd 4th

4th 1st 2nd 3rd 4th


6. Prevention of risk of fallingFalls are events that may cause injuries. Their incidence in hospi-tal environments changes in ac-cordance with the type of patient assisted: the elderly, persons with gait and balance disorders, per-sons with decreased level of con-sciousness or persons who use certain medications are more ex-posed to such incidents.

5a. Density of occurrence of blood stream infection associated with central venous catheter in critical units of

the Sírio-Libanês Hospital, compared to US hospitals

Actions takenThe institution’s prevention pro-gram includes the identification of patients with higher risk of fall, and the adoption of preventive measures, according to risk levels. The assessment is carried out on a daily basis, as from the patients’ admission, based on their clinical conditions. In regard to patients assisted in the diagnostic center, outpatient units and emergency units, the risk is determined ac-cording to the procedures per-formed. All patients are informed about the risk and the measures to prevent falls. Additionally, the hospital’s physical structure and furniture is also designed to re-duce the risks.

ResultThe institution monitors the rate of incidence of fall resulting in in-juries for inpatients.

Type of surgery Results in the 2nd half of 2015 Benchmarking (NHSN*)

Hip replacement 4.41% 0.54%

Mastectomy 0.83% 2.26%

Herniorrhaphy 0 1.58%

Thyroidectomy 0 0.24%

Colon surgery 4.49% 2.4%*NHSN: National Healthcare Safety Network

6. Rate of incidence of falls resulting in injuries for

patients (1,000 patients-day)

4º

1.3

1

QUARTER


NHSN Benchmark - percentile 50 (2011)

2014

1.2 0.8 1.74 0.5

1º 2º 3º 4º

2015


4º

0.47

0,5

QUARTER


Benchmark PatientCare link (2011-2012) Massachusetts (USA)

2014

0.48 0.5 0.32 0.52

1º 2º 3º 4º

2015


1.1

0.77

5b. Occurrence of infection in the surgical site after the procedure


Certifications received in 2015

Commission on Accreditation of Rehabilitation Facilities (CARF), which recognizes the quality of rehabilitation programs offered by the institution. The Sírio-Libanês Hospital was the first private health center in Brazil to be awarded this certification.

ISO 14001, focused on environmental management, it recognized the institution’s efforts to reduce the impact of its operations on the environment through actions such as proper disposal of waste, recycling, composting and rational use of electricity.

OHSAS 18001, which certifies the use of good practices regarding employees’ health and safety.

Selo Amigo do Idoso [friend of the elderly seal], granted by the São Paulo State Government to institutions that develop good practices and projects focused on persons above 60 years old. The organization was the first to achieve the highest level available. (G4-

15) Accreditation Canada, from Canadian Council on Health Services Accreditation, which analyzes the transparency and safety of management and healthcare practices in comparison to global benchmarks. (G4-15)

The certification granted by the Joint Commission International (JCI), which is the world’s leading certification for safety and qua-lity of healthcare services, was awarded in 2007 and renewed in 2014, as part of the validation pro-cess conducted by the entity each three years. The next phase is ex-pected to take place in 2017.


Efficiency and productivity

Having the productivity plan as the focus of our work in 2015, health-care operations were significantly redesigned to ensure greater ef-ficiency in the performance of ac-tivities. The higher number of beds and the search for sustainability in all phases of the process were criti-cal factors for this change.

The opening of Building D and the implementation of new nurs-ing stations in each unit increased complexity of healthcare activities.

On the other hand, our joint ef-forts resulted enhanced the value of healthcare activities, enabled a closer relationship with patients, employees’ satisfaction and reduc-tion of indicators such as falls and failures, generating efficiency and safety.

Changes were also observed in the Hospitality area, particularly re-

garding hygiene and cleaning rou-tines. The use of extractor washing machines that are less dependent on human handling lends more ef-ficiency to the hygiene of hospital materials. With these machines, the washing process was redesigned to enable the classification of differ-ent unit areas and patients in ac-cordance with their demands.

In addition to the new healthcare operation model, a new strategy named “PULL” was putting place in 2014, being fully implemented in 2015. It consists of an optimized human resources allocation sys-tem with more efficient planning and control. The strategy was de-signed based on the inputs of a consultancy firm, and a study was conducted to measure the average occupancy of the units. The study took into account three aspects: occupancy, number of resources per shift, and seriousness (com-plex patients demanding high level of attention). A monitoring center

In accordance with the efficiency and productivity plan, the operations were redesigned to enable optimization of resources, with savings of over R$ 10 million, and the improvement in healthcare assistance, with a closer relationship between professionals, patients and companions.


controls the flow of units on a daily basis so as to improve the move-ment of teams and the quality of the assistance provided. The most significant results were a reduction, by almost 100%, of comp time, and savings of R$ 10 million for the hospital. For 2016, this project is expected to be used in the Diag-nostic Center, in the Laboratory, and in the Emergency Service Unit.

Technology for the good

Health informatics is a differential of the Sírio-Libanês Hospital, and its scope of action ranges from management support to special-ized technical aspects, such as medical imaging management. Seeking to improve the relation-ship with patients, and ensure en-hanced safety and quality to the assistance provided, several proj-ects based on technology devel-opment started or were deployed in 2015.

Through the self-service sys-tem now available at the Itaim Unit, patients use their Individual Taxpayer’s Register (CPF) or ap-pointment protocol for identifi-cation, and inform whether they need assistance or whether they have all the documents required to start their tests immediately. As a result, those who have met all requirements are referred to the tests scheduled more quickly, thus also avoiding delays. With the self-service system, 85% of patients are seen within the tar-gets established for the different waiting lines.

The institution’s call center start-ed to use the Avaya platform, which provides for a more accu-rate analysis of the answers to calls, and generates information that help improve the manage-ment of the service. With this new tool, 85% of calls were an-swered in less than 30 seconds. In addition to improving service, the platform also schedules ap-pointments and make call backs (automated return calls). The area won 10 new answering positions and expanded to another floor in the administrative building of the Bela Vista complex.

Also in 2015, the electronic ques-tionnaire was gradually made available, seeking to facilitate and accelerate the healthcare pro-cess. Upon their arrival to the site where tests will be done, patients are welcomed by a professional who gives them a tablet on which they input the data required for the tests. The answers are imme-diately sent for analysis by the healthcare professional respon-sible for the procedure. These data are included in the medical records of the patient, and may be used in future tests, upon a simple check, occasional updates or inclusion of additional informa-tion related to a specific proce-dure. The electronic questionnaire is currently in use at the Diagnos-tic Center of the Itaim Unit, and it is being implemented at the Bela Vista hospital complex. (G4-26).

MULTIDISCIPLINARy PORTALAfter the continuous improve-ment of the Patient’s Portal, a web platform developed in 2008, and the implementation of the Physician’s Portal and the Onco-logy Portal in 2014, the institution started to develop the Multidis-ciplinary Portal. Currently under construction by the Information Technology team, the platform will enable technological advan-ces, such as the recording of data relating to nursing, nutrition and physiotherapy activities. Through the use of archetypes (an origi-nal model from which similar in-formation is derived), the portal will provide a single, more com-prehensive and intelligent repo-sitory of patient data available for use. In addition to improving the services provided to patients, this technology should become a benchmark in Brazil. The best tool currently available on the market has an extremely high cost and is developed abroad.


The clinical governance of the Sírio-Libanês Hospital has been developed throughout the insti-tution’s history, in a continuous process of improvement that cur-rently relies on six pillars:

•Continuing education: ongoing education of professionals.

•Clinical audit: permanent re-view of physicians’ performance within a cyclical quality improve-ment process. In 2015, the audit was expanded to include more indicators of patients’ individual monitoring.

•Clinical effectiveness: develop-ment of best practices, such as cost effectiveness of therapeutic interventions.

•Research and development: de-velopment of innovative prac-tices and processes based on scientific evidence.

•Transparency of information: open discussion of health issues, also regarding healthcare risks and safety, aiming at engaging patients and professionals.

•Risk management and develop-

ment of tools for improvement: initiatives that seek to increase the patient’s safety. In 2015, the management of risks was more decentralized, resulting in more effective and continuous im-provements.

As responsible for establishing a patient care model, clinical gov-ernance has been focusing since 2008 on the integration of the multiprofessional group, com-pleteness and organization of healthcare; and encouragement of an active participation of in-dividuals and their families in the treatment. This co-participation in care management is one of the strengths of the model, which is inspired in practices used in Eng-land.

With the purpose of embedding the model in the institution’s cul-ture, several processes and proj-ects were developed in the past seven years, such as the imple-mentation of the Multidisciplinary Care Program in 2014. In 2015, the technological advances made in the Patient’s Portal and the Physi-cian’s Portal, and innovative tools such as the notice on critical find-ings (which notifies the physician

in charge in cases of highly-crit-ical results and diagnosis), have contributed to the model’s con-solidation and the search for per-manent improvement.

See below other clinical gover-nance initiatives conducted in 2015:

•Development of the patient’s safety specialization program (200 nurses graduated in the 2014-2015 class, and another 1,200 graduates are being ex-pected for 2015-2016).

•Incorporation of new medical protocols: hypo and hypergly-cemia, vancomycin control at critical units, control of antibiot-ics (supported by the automa-tion of the hospital’s pharmacy), and control of the administra-tion of doses.

•Holding of the 2nd Meeting on Critical Analysis of Medical Practice, which discussed the improvement of standards and protocols relating to clinical ef-fectiveness. In 2015, the event had the participation of Marco Bobbio, an Italian surgeon spe-cializing in cardiovascular dis-eases and medical statistics.

Clinical governance

(G4-26, PR1)


In 2015, the Sírio-Libanês Hos-pital participated in major tra-de fairs and congresses where it emphasized its state-of-the-

-art research and practices es-tablishing a leading role for its healthcare model in clinical go-vernance. They were:

•22nd Hospitalar fair, where the institution presented to the au-dience its consulting programs in health and healthcare and people management projects, as well as educational and re-search projects.

•MEDINFO 2015, the world’s most important health informat-ics event, held by the Brazilian Society of Health Informatics

The patients’ view about their involvement in healthcare

(G4-26, DMA, PR5)

As part of a new process started in 2015, Quality Management pre-pared a questionnaire on the ex-pectations of patients about their involvement in the healthcare process. They are asked about their understanding of the proce-dures to which they will be sub-mitted at the hospital and their wider implications.

The questions included in this ap-proach are as follows:

•Has the information regarding your treatment and care been made available in a timely and clear manner?

•Did the team listen to and re-spect your individual needs?

•Was the multiprofessional team (physician, nurse, nutrition-ist, physiotherapist, pharmacist etc.) aligned/integrated regard-ing your treatment?

•The rate of response in 2015 was 88%, or 1 percentage point above the target established by the institution.

(SBIS). The institution present-ed IT projects applied to health and received local visits.

•41st CONARH, the largest meet-ing on people management in Latin America, and the second in the world. The event is at-tended by Human Resources professionals from all regions of Brazil.

•3rd International Accreditation Congress, held by the Brazil-ian Accreditation Consortium (CBA) and the Joint Commis-sion International (JCI). The event discussed methodologies focused on the excellence and safety of all persons involved in the healthcare processes.

DIALOGUE AND BENCHMARK


Operating performance

Bela Vista complexThe year 2015 was marked by the opening of the new towers at the Bela Vista unit. Compared to 2013, the institution created 79 new beds in 2014 and 2015. The occupancy of the whole installed capacity of beds should be com-pleted by 2017, when 611 beds are expected to be operating.

Indicators (Bela Vista, São Paulo) 2013 2014 2015

Operating beds 372 439 451

Critical patients-day 50,026 52,399 60,214

Non-critical patients-day 66,255 72,809 71,485

Patients-day 116,281 125,208 131,699

Discharges 18,840 20,632 23,238

Admissions 18,221 20,683 23,263

Operating occupancy rate 89.6% 85.6% 86.03%

Average stay (days) 6.17 5.97 5.67

Number of tests/procedures (Bela Vista, São Paulo) 2013 2014 2015

Tomography 57,096 57,377 64,272

MRI (Magnetic Resonance Imaging) 36,470 40,627 51,355

Ultrasound 114,302 114,328 126,838

General radiology 124,781 122,774 127,215

Endoscopy 21,030 23,770 27,608

Surgical Center 13,736 13,860 14,685

Pathological Anatomy 68,858 73,662 100,001

Electrocardiogram 3,961 4,700 5,272

Holter monitoring 2,918 3,050 3,645

ABPM (ambulatory blood pressure monitoring) 1,855 1,732 2,111

Tilt-table test 609 583 575

Ergometric Test 13,827 11,942 11,683

Echocardiogram 22,256 24,919 25,547

The operating performance de-rives from strategic manage-ment, which associates tools, information on trends, scenarios and indicators that guide the definition of projects and in-vestments. The new towers re-sult from this process, having enabled an increased number of patients assisted in inpatient

units, and external patients who use our support and diagnostics services, emergency services, and others with no need for hos-pitalization. In most cases, the number of patients assisted by all healthcare sectors and servic-es remained stable or increased against the previous year, ac-cording to the table below:


Specialty centers and advanced medicine unitsThe specialty centers and ad-vanced medicine units of the Sírio-Libanês Hospital have pro-fessionals from different areas of knowledge who work in an inte-grated manner to prevent, diag-nose and treat patients seeking specialized services. In 2015, the institution registered 5,793 as-sistances and 8,526 medical ap-pointments, an increase of 36% in comparison to the previous year.

Below are the hospital’s special-ty centers and advanced medi-cine units:

•Health Monitoring and Check-up Center

•Cardiology center•Diabetes center•Multiple Sclerosis and Related

Diseases Center•Immunization center•Nephrology and Dialysis center•Oncology center•ENT center•Rehabilitation center•Human reproduction center

•Integrated bone health center•Skin cancer unit•Hand surgery and reconstruc-

tive Microsurgery unit•Integrative care unit•Pulmonary and thoracic dis-

eases unit•Pain and Movement disorders

unit•Complex wounds unit•Liver unit•Geriatrics unit•Hemorrhage and thrombosis

unit•Infectology unit•Mastology unit•Exercise and Sports Medicine

unit•Neurology and Neuroscience

unit•Obesity and eating disorders

unit•Shoulder and elbow unit•Hip unit•Rheumatology unit•Ankle and foot unit•Urology unit

36% GROWTH IN ASSISTANCE

AND APPOINTMENTS IN OUR CENTERS AND UNITS IN 2015

IN COMPARISON TO 2014


Itaim UnitThe Itaim unit makes available image and lab tests, clinical on-cology, cardio-diagnosis, day hospital, surgical center, patho-logical anatomy analyses, human reproduction and check-up ser-vices. This unit registered an 18% growth in assistance compared to the previous year.

Jardins UnitThe Jardins unit expanded its scope of action to assist male patients. Until 2014, this unit was exclusively focused on women’s health.

One of the most important proj-ects in 2015 was the purchase of a new MRI device. Image and lab tests, pathological anatomy analyses, urodynamics, genetic counseling, and bone health di-agnostics and treatments are also available. The unit registered 25% growth in assistance compared to the previous year.

Oncology CenterThe institution offers oncological treatment at the Bela Vista com-plex and the Itaim and Brasília (Asa Sul and Lago Sul) units.

In 2015 there was a significant increase in the number of treat-ments: 10%. The Bela Vista unit assisted over 30 thousand per-sons in the period, receiving some 650 new patients for treatment throughout the year. The Itaim unit registered 11,559 assistances, 16% growth against the previous year.

Together the Brasília units record-ed even more positive results, with an increase by 47% in the number of persons assisted, and 51% growth in revenues.

Cardiology unitThe cardiology unit is present at the Bela Vista complex and the Itaim and Jardins units, all in São Paulo. In 2015, the number of tests conduct-ed increased more than 5%.

Voluntary work

With 35 years of history, the Vol-unteer Service provides support and human warmth to patients, their companions and families, seeking a better adaptation of these persons to the hospital en-vironment. The group has 270 members who are committed to promoting humanization through conscious and professional work.

•Bela Vista and Itaim: volunteers operate in areas such as diag-nostic center, emergency ser-vice, oncology center and Inten-sive Care Unit (UTI), in addition to the Pediatrics Specialties Out-patient service, the Abrace seu Bairro program and the Philan-thropy Outpatient service. They are responsible for the book-store and the convenience store, whose income is allocated to the institution’s social responsibility area.

•Brasília: since 2014, our volun-


Performance of Itaim Unit 2013 2014 2015 2015 x 2014

Cardio-diagnosis 8,654 12,072 13,235 9.63%

Surgeries 1,500 1,759 1,734 -1.42%

Imaging exams 42,349 53,840 62,693 16.44%

Endoscopy 6,278 7,081 7,410 4.65%

Human reproduction 2,453 3,134 3,430 9.44%

Clinical oncology 6,557 9,950 11,559 16.17%

Laboratory exams 436,187 561,835 662,053 17.84%

Pathological anatomy 6,928 11,539 16,237 40.71%

Check-up (as from Feb/2014) - 3,927 4,423 12.63%

Other exams 1,398 1,920 1,527 -20.47%

Grand total 512,304 667,057 784,301 17.58%

Performance of the Oncology Center 2013 2014 2015 2015 x 2014

Clinical Oncology at Bela Vista unit 30,605 30,532 30,396 -0.45%

Clinical Oncology at Itaim unit 6,557 9,950 11,559 16.17%

Clinical Oncology in Brasília (Federal District) 15,464 18,907 27,778 46.92%

Radiotherapy at Bela Vista unit 17,515 16,486 17,044 3.38%

Radiotherapy in Brasília (Federal District) 1,466 5,010 7,932 58.32%

Total 71,607 80,885 94,709 17.09%

Performance of the cardiology unit 2013 2014 2015 2015 x 2014

Bela Vista complex 45,426 46,926 48,833 4.06%

Itaim Unit 8,654 12,072 13,235 9.63%

Jardins Unit - 36 60 66.67%

Total 54,080 59,034 62,128 5.24%

teers have been present in the two units of Brazil’s capital city (Asa Sul and Lago Sul), dissemi-nating a volunteering institu-tional culture, and supporting and guiding the patients, their companions and families.

•Menino Jesus Municipal Chil-dren’s Hospital: since 2009, our volunteers have been present in the outpatient service, emer-gency service unit, day hospital and the Hora da Mamãe [Mom’s time] program, which is devel-oped with mothers and com-panions of inpatients, contribut-ing to the humanization of the services provided by the hospi-tal.


To fulfill its mission, the Ladies’ Beneficent Society – Sírio-Libanês Hospital is devoted to health in integration with education, re-search and development of social responsibility projects. Accord-ingly, it contributes for the edu-cation of professionals by gener-ating knowledge and supporting the development of health in the country.

The foundation of the Sírio-Libanês Education and Research Institute (IEP), in 1971, clearly showed the objective to invest in the improvement of physicians, healthcare professionals and managers, through education and encouragement of scientific investigation, by offering an in-frastructure for such activities. By doing so, the organization con-tributes to both attracting and re-taining talented people, and play-ing a leading role in health.

IEP’s innovation also involves its teaching and learning model, which consists of an active meth-odology based on constructiv-ism. This process enables integra-tion between theory and practice,

since it simulates real issues and stimulates reasoning. This is how the institution intends to continue attracting, qualifying and educat-ing innovative professionals for the market, for the benefit of all patients.

Education and research

The importance of the Sírio-Libanês Hospital arises from innovation and the generation of

knowledge, a combination that brings positive results for the whole society (G4-26, DMA, EC7, EC8)

24,000 PARTICIPANTS ATTENDING

IEP’S ACTIVITIES

•6 thousand-m2 area

•Advanced center for training and simulation in videosurgery, microsurgery, video-endoscopy, electrosurgery and robotics con-nected to audio, video, data and videoconference systems.

•Telemedicine room for meetings and events via conference call and videostreaming (live broad-cast).

•Six auditoriums and one amphi-theater with 400 seats offering audio, video and data broadcast-ing systems.

•Computer laboratory

•Auditorium for simulation of healthcare practices

•4 meeting rooms

•Academic office

•Library

•Wi-fi

IEP INFRASTRUCTURE


Partnership Model

To fulfill its mission, IEP operates in combination with public and private institutions whose target is also excellence in healthcare, respect for people and commit-ment to society. In regard to re-search, our partnerships include the Ludwig Institute for Cancer Research (setup of the Molecu-lar Oncology Center); the Me-morial Sloan-Kettering Cancer Center (collaborative education and training programs in oncol-ogy, as well as symposiums); and the State of São Paulo Cancer In-stitute (Icesp), among other. We

By generating knowledge and developing new technologies, the Sírio-Libanês Hospital becomes qualified for teaching, attracting and graduating professionals and multipliers of assistance with ex-cellence. To this end, it develops different actions that include con-tinuing education and counted on 263 participants in two multi-professional courses in 2015, and conducts scientific meetings that total some one thousand events per year, with the purpose of presenting and discussing clini-cal cases among its own groups. Other specific educational activi-ties are as follows:

CMIRA

The CMIRA program (medical competence with a new approach to student mobilization, interna-

tionalization of medical schools, medical residency and assess-ment of competence) seeks to support medical schools in Brazil, and has been implemented by IEP in six institutions in 2015. In total, the program put together 350 students in Uberaba and Patos de Minas (Minas Gerais), Aracaju (Sergipe), Joaçaba (Santa Cata-rina), and Maringá (Paraná).

Medical education

This project comprises 76 cities in Brazil, and consists of the edu-cation of 200 medical residency managers. New medicine courses approved by the Ministry of Ed-ucation will be implemented in these cities. These managers will be responsible for developing res-idency programs, structuring all processes, as well as monitoring

Education

also have partnerships with the University of São Paulo (USP) and the Federal University of São Carlos (UFSCar) for creation of graduate degree programs.

Together with the National Board of Medical Examiners (NBME), a 100-year-old institution that evaluates health professionals worldwide, we planned a tool to support the improvement of med-icine teaching in Brazil. The proj-ect is intended at public and pri-vate schools of medicine, with the purpose being to generate infor-mation and improve the courses offered. (G4-26).

150 SCIENTIFIC ARTICLES

PUBLISHED IN BRAZILIAN AND INTERNATIONAL SCIENTIFIC JOURNALS

25 NEW AGREEMENTS WITH THE PHARMACEUTICAL INDUSTRY

FOR CLINICAL TRIALS

16 RESIDENCY IN HEALTH AREAS, TOTALING 270

RESIDENTS


pedagogical aspects and the reg-ularization of regional hospitals.

Emergency and trauma qualification

An advanced training center in this area has been in operation since 2005. The program had 800 participants in 2015.

Exclusive courses

With a focus on the market, the IEP developed 20 high added-val-ue courses based on the special-ization and knowledge involved. Ten percent of the places are of-fered to the medical stall of differ-ent areas of the hospital, aiming at the continuing improvement of the institution’s human capital. The demand for these courses is growing due to external recogni-tion and the possibility for profes-sionals to take advantage of the hospital’s excellent infrastructure, experienced clinical staff and cut-ting-edge technology.

Graduate programs and residency

The IEP offers courses for physi-cians, nurses and other healthcare professionals, allocating part of the places available to scholar-ships offered to persons working in public institutions.

1. Lato sensu graduate programs

1.1 Specialization•329 professionals trained in 19

courses•Minimally invasive urological sur-

gery•Coloproctology

97,000STUDENTS AND

PROFESSORS ENROLLED

IEP EDUCATION PORTAL

57% INCREASE IN THE NUMBER OF USERS IN THE PAST 12

MONTHS

GREATEST NUMBER OF ACCESSES: STATES OF SÃO

PAULO, MINAS GERAIS, CEARÁ, PARANÁ, RIO DE JANEIRO, PARÁ, DISTRITO

FEDERAL AND MATO GROSSO DO SUL105,000

POSTS ON ON-LINE DISCUSSION FORUMS

24,000ACTIVE ENROLLMENTS

•Care of patients in pain•Palliative care•Endometriosis and minimally in-

vasive gynecology•Therapeutic digestive endoscopy•Cardiology nursing•Digestive endoscopy nursing•Intensive care nursing•Healthcare management•Health informatics•Pharmaceutical medicine•Intensive medicine for adults•Neurointensive care for adults•Neuro-oncology•Assisted reproduction

1.2 Improvement •Pediatric anesthesia and inten-

sive care•Regional anesthesia•Palliative care

2. Strictu sensu graduate programs – 92 students

•Academic master’s degree in health sciences

•Academic doctor’s degree in health sciences

•Professional master’s degree in technology management and in-novation in health


Multi-area residency

The residency program comprises other fields of knowledge, in ad-dition to medical specialties. This activity is a major point of inte-gration between education and the assistance provided by the Sírio-Libanês Hospital. In 2015, 270 residents attended the ac-tivities, supported by preceptors and tutors. The nursing residency class had 25 students, of which 24 were contracted by the hospi-tal, evidencing the connection be-tween education and healthcare in the institution.

Courses, conferences and meetings

The IEP offers a range of educa-tional activities at its own prem-ises. Some activities are in-house, while other are available as dis-tance learning. The institute host-ed over 60 courses and confer-ences in 2015, including:

•19th International Colonoscopy Course – 4th Hands-on course in Diagnostic Colonoscopy

•2nd Symposium on Acute Coro-nary Syndrome

•2nd International Symposium on Coloproctology – Centenary of the Birthday of Dr. Daher Cutait

•Intersections•2nd Symposium on Quality and

Patient’s Safety•6th Course on Acute Kidney Injury•Clinical practice with Auditory

Brainstem Evoked potentials•Symposium on the Therapeutic

Use of Botulin Toxin•15th Course on Latest-Genera-

tion Radiotherapy and Prostate Brachytherapy

•4th Pharmacy Forum•5th International Practical Course

on Mechanical Circulatory Support•3rd Symposium on Cardiology

Emergency•3rd Journey on Orthognathic

surgery and Orthodontics•4th Course on Intestinal Inflam-

matory Diseases

The Sírio-Libanês Hospital was the first hospital in the southern hemisphere to conduct a robot--guided telesurgery. The procedu-re was carried out simultaneously with a US physician. Later on, ro-botic surgery was included in the institution’s care practice with the acquisition of two da Vinci S robots, one for surgeries and another one for training progra-ms. The hospital also purchased a more advanced robotic system named da Vinci Si.

The experience accumulated throughout this period enabled the creation, in June 2015, of the Robo-

tic Surgery Center, which seeks to expand exchange among different medical specialties in robotic sur-gery technology. The center puts together experienced professionals and beginners in the use of this te-chnology, and trains professionals of the State of São Paulo Cancer Institute (Icesp), a public institu-tion that assists patients of the Brazilian Public Healthcare System (SUS). The training program has an average duration of 8 hours, being conducted by professionals of the Sírio-Libanês Hospital, and discus-sing robotic surgeries in the areas of urology, head and neck, and di-gestive system.

LAUNCH OF THE ROBOTIC SURGERy CENTER 2016 SELECTION PROCESS FOR LATO SENSU GRADUATE

PROGRAMS

A selection process was started in September 2015 for 18 cour-ses designed for healthcare pro-fessionals and managers, to be delivered in 2016. The courses include 15 specializations and 3 improvement programs.


SPECIALIZATION UNDER MEDICAL RESIDENCY REGIME

AND ADDITIONAL YEAR

15 residents

Echocardiography Echoendoscopy

PET/CT and SPECT/CT Abdomen radiology

Heart radiology Radiology intervention

Chest radiology Radiology – Ultrasound I Radiology – Ultrasound II

Breast radiology Bone marrow transplant and

onco-hematology

IEP RESULTS IN 2015

MEDICAL RESIDENCY

97 residents Anesthesiology

Cancerology Cardiology

Medical clinic Endoscopy Mastology

Intensive medicineRadiology/Diagnosis Imaging

Radiotherapy

MULTIPROFESSIONAL RESIDENCY

79residents

Care of critical patientsCare of patients with cancer

HEALTHCARE PROFESSIONAL AREA RESIDENCY

79 residents

Biomedicine in diagnostic imaging

Clinical-surgical nursing Surgical center and sterilization

unit nursing Urgent and emergency nursing Medical physics in radiotherapy

452015 SuStainability RepoRt 45RELATóRIO DE SUSTENTABILIDADE 2015

EDUCATION IN SUPPORT OF THE SUS (G4-26)

The partnership established with the Ministry of Health aims at qualifying professionals of the public healthcare system (SUS). On-site meetings and conference calls are held with members of the Ministry, the National Council of Health Secretaries (Conass), and the National Council of Municipal Health Departments (Conasems) to identify public health needs and opportunities to influence and support public policies; encour-age the dissemination of knowl-edge; and promote the advance of health initiatives based on the hospital’s management, healthcare and education expertise.

This partnership is in line with the specific philanthropic legislation in force for hospitals deemed as institutions of excellence and fo-cused on research and manage-ment qualification through the SUS Development Support Pro-gram (Proadi/SUS). By attending these courses, SUS managers dis-cuss the experiences and needs arising from their routines, and provide support for the creation of educational projects that can be disseminated in different rregions, according to the local reality.

A new three-year period (2015-2017) of Proadi/SUS was started in 2015. The initiative should reach 5 thousand professionals in more than 50 regions of Brazil. In the first year, the project was marked by the collective construction of educational activities through the use of the institution’s expertise and continuity of the initiatives conducted in the previous three-year period (2012-2014).

SUS MANAGERS

DETERMINATION OF DEMAND BY THEME AND REGION

SÍRIO-LIBANÊS EDUCATION AND RESEARCH INSTITUTE

DEVELOPMENT OF COURSES AND KNOWLEDGE

COMMITEE

MINISTRY OF HEALTH

NATIONAL COUNCIL OF

HEALTH SECRETARIES

NATIONAL COUNCIL OF MUNICIPAL

HEALTH DEPARTMENTS

HOW COURSES ARE DESIGNED FOR SUS (G4-26)

Currently, the greatest challenge is to gather and analyze the assess-ment of the students who partici-pated in IEP’s projects and courses. This group is responsible for devel-oping projects focused on their rel-evant areas, as well as knowledge with a potentially high impact.

In 2016, the indicators measuring this impact will be better struc-tured, and therefore will enable information to be obtained on is-sues such as the density of educa-tion and its relationship with the local development. This important transparency tool enables the as-sessment of the fulfillment of ob-jectives involved in the partner-ship with SUS.


2009-2014 RESULTS

NUMBER OF CITIES ASSISTED By SUS SUPPORT PROJECTS, By REGION

16,395 FINAL TERM PAPERS

1,384

17 IMPROVEMENT COURSES, AND

8,867 GRADUATE DEGREE

STUDENTS CERTIFIED

22 SPECIALIZATION COURSES, AND

10,272 SPECIALISTS CERTIFIED

16

9

1743

3839

courses DELIVERED IN THE

PERIOD, AS FOLLOWS:

4 IMPROVEMENT COURSES

8 REFRESHER COURSES

3 QUALIFICATION COURSES

24 SPECIALIZATION COURSES

PROJECTS CONDUCTED IN 372 HEALTH REGIONS


2015: start of the three-year period and development

of new projects

In 2015, the IEP started another three-year period of partnership with the public healthcare sys-tem (SUS), promoting the quali-

fication of professionals working in the public sector in different regions and appointed by the Ministry of Health. We started 12 specialization courses, 2 improve-ment courses, 2 refresher courses and 1 professional master’s de-gree course, with participation

Program Category 2015 Results

Qualification in evidence-based health Refresher course 6,469 participants

Qualification in right to evidence-based health Refresher course 1,353 participants

SUS federal management Improvement 159 participants 18 facilitators

Risk and safety management in patient care Specialization1,040 participants 21 managers 62 facilitators

Qualification in educational processes in healthcare Specialization 360 participants 30 managers

Health educational processes with emphasis on active methodologies Improvement 1st edition: 220 participants and 15 facilitators

2nd edition: 300 participants and 30 managers

Clinical management in health regions Specialization800 participants (40 per health region) 20 managers 40 facilitators

SUS health regulations Specialization800 participants (40 per health region) 20 managers 40 facilitators

Management of evidence-informed health policies Specialization 400 participants 22 facilitators

Health education for SUS preceptors Specialization1,200 participants 60 facilitators 15 managers

Educational health processes with emphasis on significant learning Specialization 242 participants

30 managers

SUS medical residency preceptors Specialization1,280 participants 14 managers 64 facilitators

Sanitary surveillance management Specialization400 participants 10 managers 20 facilitators

Health surveillance management Specialization800 participants 30 managers 28 facilitators

Emergency management in public health Specialization 200 participants (20 per health region) 11 facilitators

Management of federal university hospitals in SUS Specialization

15 participating hospitals (States of Sergipe, Mato Grosso do Sul, Mato Grosso, Ceará, Paraíba, Minas Gerais, Alagoas, Rio Grande do Norte, Rio de Janeiro, Paraná, Pernambuco, Bahia and Rio Grande do Norte) - 16 facilitators

Professional master’s degree in technology management and innovation in health

Stricto sensu graduate degree

24 participants323 enrollments in 2015

* Course details are available at https://iep.hospitalsiriolibanes.org.br


of approximately 16 thousand people, enabling dissemination of knowledge in more than 200 municipalities. This reach is part of an innovative project that in-cludes on-site and distance learn-ing, and uses conference calls and digital teaching platforms.

The purpose of the courses is to support regional public policies by encouraging the evolution of public health actions and a critical think-ing about the routines and local re-ality. During the course, SUS man-agers talk about their experiences and the needs of their regions, pro-viding support for the construction of action plans that can be dissemi-nated and used in practice.

ResearchResearch is one of the pillars sup-porting the hospital’s actions, and it is effectively integrated into our healthcare, educational and social responsibility activities. Teach-ing and qualifying professionals, building new knowledge, and encouraging innovation are ac-tions aligned with the institution’s strategy, being essential for the fulfillment of our commitment to the Brazilian society.

The continuous evolution of the research, development and inno-vation area is in line with a quite evident movement that is taking place in the best hospitals world-wide. The union of these activities will benefit the patients, since it will result in increasingly custom-

ized healthcare based on the best evidences, with greater quality and safety, in accordance with the characteristics and needs of each person. Accordingly, devel-oping a well-structured research area in line with the institution’s needs is essential for the continu-ous improvement of the services provided.

By developing knowledge gener-ation initiatives, the hospital con-tributes to healthcare as a whole, reinforcing its commitment to ex-cellence and pioneering. As the institution generates and dissem-inates knowledge, and creates new therapeutic approaches, it also becomes capable of per-forming educational activities.

In regard to new projects, we highlight the initial support pro-vided to public and private institu-tions for implementation of medi-cine courses. The objective of this partnership is to build and imple-ment the pedagogical process, provide support for infrastructure adjustments; qualify course pro-fessors, preceptors, and manag-ers, and act as an interface with the local public health network. The initiative aims at contributing with IEP’s expertise in health care, education and management areas, within a project guided by innova-tion in medical education and im-provement of the Brazilian health system.

DEVELOPING A WELL-STRUCTURED RESEARCH AREA IN LINE WITH THE INSTITUTION’S NEEDS IS ESSENTIAL FOR THE

CONTINUOUS IMPROVEMENT OF THE SERVICES PROVIDED


Research is part of a system that leads to the excellence of the healthcare process. This provides two important elements for the institution’s researchers: clinical information and biological sam-ples of patients. The hospital’s actions are totally dedicated to the development of applied re-search, with a focus on improve-ment or solutions for healthcare-related issues.

To better encourage this knowl-edge generating environment, the hospital provides infrastructure for laboratories, human resources, administrative and regulatory sup-port, and funding, among other, enabling the interaction among healthcare staff and researchers, so that together they may de-velop solutions and innovation for improving healthcare.

This relationship lays the ba-sis for creation of the academic master’s and doctor’s degree in health science. In its seventh class, the program’s faculty has approximately 40 professionals and 86 students’ pursuing a de-gree. It has also recorded 17 dis-sertations and degrees awarded (16 master’s degrees and 1 doc-tor’s degree).

At a moment of consolidation of the hospital’s growth, research activities are even more crucial, since growing with quality will depend on the ability to count on persons who are willing grow towards knowledge, pioneering and excellence. Education and research are essential to attract and retain talented persons.

Benefits for society

Research brings benefits for so-ciety in a number of ways, since new knowledge, technology, a new medication or surgical pro-cedure, for example, can have a huge multiplying potential.

In addition to these extended benefits, our research studies are also used for providing care to SUS patients. Currently, of 156 patients that participate in clinical trials and have access to drugs not available on the market, more than 50% came from SUS.

Publications

The year 2015 saw an increase in the number of articles published, as well as qualitative improve-ments, considering the relevance

THE VIRTUOUS CyCLE OF KNOWLEDGE GENERATION

GENERATION OF NEW

PRODUCTS

IMPROVEMENT OF PATIENT’S

CARE QUALITy

KNOWLEDGE GENERATION

PEOPLE EDUCATION AND QUALIFICATION

GREATER GENERATION

OF KNOWLEDGE

DEVELOPMENT OF NEW TECHNOLOGIES


of national and foreign journals where these studies were pub-lished. There were 150 articles published in the period, mean-ing 14% growth in comparison to 2014.

Development and innovation

In 2015, the hospital achieved im-portant results regarding the con-solidation of its development and innovation culture. Generating knowledge and conducting re-search mean turning money into knowledge. We highlight some actions:

Oncology Innovation and Devel-opment Laboratory: as a result of important donations made by two contributors, the Oncology Inno-vation and Development Labora-tory was concluded in 2015. This unit dedicates to the development of new knowledge generated from molecular oncology research transforming this knowledge into new tests. Two tests were validat-ed. In 2016, they will be released for use by the hospital’s patho-logical anatomy service, which will help diagnosing cancer patients.

Usability Laboratory: engages final users – that is, health pro-fessionals – in the development of new products, equipment and software, and enables that health-care services or products have already been subject to prior test by the professionals when they reach the market. In 2015, we signed three agreements with do-mestic companies, and delivered two results regarding the devel-opment of anesthesia and infusion pumps.

Development of new technolo-gies in partnership with the pharmaceutical industry: in 2015, 25 new agreements on clinical trials were signed in partnership with the pharmaceutical industry for development of new drugs. Clinical trials enable testing inno-vations with quality and accuracy for incorporation in protocols, or even for approval of new drugs. Currently, 156 clinical trials are un-der development at the hospital.

150 150 ARTICLES PUBLISHED

14% INCREASE IN COMPARISON TO 2014

EMPREENDA SAÚDE AWARD In partnership with everis, a mul-tinational business and technolo-gy consulting firm, and through its Foundation, the Sírio-Libanês Hospital held the 1st edition of the Empreenda Saúde award. The winner, Paula Renata Cerdeira Go-mez, presented an algorithm that contributes to early detection of epileptic seizures. This award, al-ready held in Spain, was adapted to stimulate health innovations in Brazil. The demand for changes in this area resulted in great suc-cess: 264 enrollments, 94 projects submitted and 49 candidates ap-proved. Papers were analyzed by a jury that included specialists in the areas of education, research and innovation, and health entre-preneurs. The award consisted of a specialized consulting service offered to support the author in the implementation of the idea, in addition to a financial aid of R$ 50 thousand.


Intellectual protection

The Sírio-Libanês Hospital main-tains a strict intellectual protec-tion policy regarding inventions, transforming the knowledge gen-erated inside the institution into registered patents worldwide. One Brazilian and one interna-tional patents office provide ad-visory on intellectual property is-sues. Two applications have been filed. One has already been grant-ed in Europe, being protected in 12 countries, while the other was approved in Japan and Israel, and is waiting for approval in Europe, China, South Korea, and the Unit-ed States. The two patents are be-ing negotiated for licensing.

Research fields

•Epidemiology and management in critical units

•Cardiorrespiratory physiopa-thology in critical patients

•Improvements in cancer pa-tients’ care

•New approaches to cancer diag-nosis and treatment

•Development of surgical tech-niques

•Liver transplant

Innovation is the path through which knowledge is turned into goods and services, generating wealth and improvement for society.


PAPERS AWARDED IN 2015

35th International Symposium on Intensive Care and Emer-gency MedicinePoster Award: Organizational factors and patients outcomes in Brazilian ICUs: the ORCHESTRA study

Authors: M Soares; JM Kahn; FA Bozza; T Lisboa; LP Azevedo; W Viana; L Brauer; PE Brasil; DC Angus; JI Salluh.

III Brazilian Meeting on Brain and CognitionHonorable mention for the pre-sentation of posters:

Pain and Parkinson’s disease: the role of bioamines over the opioid system in the nociceptive control

Authors: Ana Carolina P. Cam-pos; Miriã B. Berzuino; Erich T. Fonoff; Rosana L. Pagano.

Functional neurosurgery and chronic pain: effect of cortical sti-mulation on endogenous analge-sia in neuropathic rats

Authors: Talita S. Farias; Amanda F. N. Paschoa; Danielle V. Assis; Ana Carolina Campos; Erich T. Fonoff; Rosana L. Pagano.

University of São Paulo Func-tional Neurosurgery Conferen-ce Best oral presentation: Unrave-ling the analgesia induced by cor-tical stimulation in rats with neu-ropathic pain

Authors: Danielle V. Assis; Aman-da F. Paschoa; Talita S. Farias; Ana Carolina Campos; Guilherme D. Silva; Manoel J. Teixeira; Erich T. Fonoff; Rosana L. Pagano.

Digestive Disease WeekWorld Cup of Videos/Silver Me-dal: Endoscopic treatment of re-fractory oesophageal fistula

Author: Kiyoshi Hashiba


Generate, share and build knowl-edge. These actions are essen-tial for the fulfillment of our mis-sion. More than a commitment, social responsibility is present at the Sírio-Libanês Hospital as our reason for being. Our organiza-tion supports social, educational, research and healthcare actions aiming at developing the com-mon good by promoting health, education, professional qualifica-tion, and quality of life programs, and the availability of access and offering of complete care. These actions foster care with a focus on care lines, potentiating the use of scarce resources.

The Sírio-Libanês Hospital sup-ports the improvement of the Brazilian health system in partner-ship with the Ministry of Health. We hold courses for public health professionals aimed at different

purposes, which include the cre-ation of organs collection and transplant centers; support for treatment of rare diseases and development of research; imple-mentation of a public umbilical cord and placenta blood bank; conduction of studies on the de-velopment of cell therapy against congenital diseases; and perfor-mance of high-complex surgeries, among other projects.

The institution’s managers and employees are inspired by the wish to care, serve and provide healthcare excellence for a great-er number of persons. Accord-ingly, they work to multiply their experiences, so that more regions in Brazil may benefit from them.

In 2015, the institution achieved recognition in the report issued by DEG (Deutsche Investitions), a

Social responsibility

Professional qualification initiatives at no cost for participants; education and

research projects dedicated to the public health system; and improvements for the

surrounding community are the main highlights of our philanthropic actions (G4-26)

German investment bank and one of the sponsors of the expansion program. The document mentions the actions taken by the Sírio-Libanês Hospital in the area of so-cial responsibility, which contrib-ute to building a better society. The report emphasizes, among other, the qualification initiatives offered to the public at no cost, and our educational and research projects.

The institution also develops proj-ects to improve the quality of life of the socially and economically vulnerable Bela Vista district com-munity, in downtown São Paulo. These actions are also part of our philanthropic vocation.

The projects are divided into the broad areas listed below.


1. Human resources qualification

Seeks to contribute to the educa-tion of SUS professionals through qualification and refresher strate-gies. Learn more in the “Education and research” section (page 39).

2. Technology assessment and incorporation studies

Aims at supporting the analy-sis of the incorporation of new healthcare technologies that may improve the quality of life of the population as a whole. Learn more in the “Education and re-search” section (page 39).

Action Quantity Result

Pediatric liver transplant 33 Survival rate of 10 years in 86% of patients

Heart transplant 4 Survival rate of 3 years for 82% of patientsShort- or long-permanence implants 7

Internship 3

Qualification programs for surgeons held in Recife (Pernambuco), Vitória (Espírito Santo) and São Paulo (São Paulo)

3. Development of healthcare services management

techniques and operation

Intended to improve the opera-tion of healthcare services, this involves the devising of manage-ment techniques and/or opera-tions and the organization of data that may support research and management. This includes the projects listed below:

Support to the SOS Emergency programThis program qualifies the man-agement and assistance provided

in SUS large hospitals in cases of urgencies and emergencies. Six participating hospitals receive management support from the Sírio-Libanês Hospital: Hospital João XXII (Minas Gerais), Hospital Roberto Santos (Bahia), Hospital do Trabalhador (Paraná), Hospital São Lucas (Espírito Santo), Hos-pital Geral (Roraima) and Hospital H. Lucena (Paraíba).

Umbilical Cord and Placenta Blood BankIts purpose is to qualify profes-sionals who work in public um-bilical cord and placenta blood banks in technical collect, pro-cessing and cryopreservation pro-cedures. From 2012 to 2015, the bank qualified 45 professionals and developed a practical guide containing information about the operation of these services. It also helped to improve public banks’ working processes by qualifying these professionals.

Transplant SchoolAs a result of a partnership agree-ment signed with the Ministry of Health more than five years ago, the school currently counts on a solid multiprofessional group of experienced surgeons, nurses, pediatricians and psychologists who help broaden the access to knowledge and technical excel-lence in transplants. Physicians from all over the country receive assistance regarding the proce-dures and handling of patients in their local of origin. The summa-ry of the activities conducted in 2015 are on the chart above.

Management modernization (IFF, INI and CIN)In partnership with the Ministry of Health, it was created in 2015 a project that offers support to the


modernization of the Fernandes Figueira National Institute for the Health of Women, Children and Teenagers (IFF) and the Evan-dro Chagas National Infectology Institute (INI), which are both connected to the Oswaldo Cruz Foundation. We have also con-tributed to the implementation of the Fiocruz complex of national health institutes (CIN).

Management modernization in-cludes planning actions focused on improvement and implementa-tion of the project office, on stra-tegic management, competence profile, process management, and negotiations with the municipal and state governments, in addi-tion to a review of the architec-tural design.

4. Healthcare research in the public interest

The aim is to develop research into scientific and technological innovation to support SUS.

National Healthcare SurveyThis is an initiative in support of the development by the Brazil-ian Institute of Geography and Statistics (IBGE) of research to provide the country with data on the drivers and preconditions of health, including the elderly, the disabled, women and children, as well as problems such as dengue fever, mental health, accidents and violence.

Biological samples were collected from some nine thousand people, and the results have been used to formulate public healthcare policies.

In addition to these four major ar-eas of knowledge, recognized by the Ministry of Heath, other proj-

ects are undertaken in partner-ship with the SUS:

5. Partnership with local manager (municipality of São

Paulo and Federal District)

This partnership is intended to improve service to public health patients, by integrating the fields of care, education and research.

Imaging ProjectA unit offering ultrasound exami-nations at a single location was opened in August. Previously these tests were carried out at five separate units managed by the São Paulo city administration. The unit is managed by the Phi-lanthropy Outpatient division. It is equipped with four scanners and five rooms, four of them for ex-aminations and one for recovery. More than 29 thousand tests were carried out in 2015.

Pediatric specialties outpatient unitThe Sírio-Libanês Hospital aims at improving the living condi-tions of the neighborhood com-munity in the district of Bela Vis-ta, in downtown São Paulo. With a focus on children’s health, the Pediatric Specialties Outpatient unit received more than 5 thou-sand patients in 2015, who came to see specialists in ENT, obesity and overweight, infectology, pho-noaudiology and dental care. The outpatient unit has existed for more than 15 years. In 2013 it was accredited by the SUS and start-ed to handle pediatric cases from Bela Vista and other districts of the city.

Embrace your District program With a major impact, it is part of the health promotion, education,

professional training and quality of life programs. It focuses on mul-tidisciplinary initiatives offering a full range of services to children and families, assisting their bio-psychosocial development. More than 1700 people participated in the project during 2015, and more than 51 thousand places were of-fered in group activities.

Some of the major events arranged by the Embrace your District pro-gram in 2015 are listed below:

Active Citizenship: provided in-house training for professionals through a partnership between the people management and phi-lanthropy superintendences.

Support for social and educational action: the institution encourages the social inclusion of young ap-prentices. 125 young people were trained in 2015.

Training for Hospital Catering Staff: the institution trains people to work in the hospital catering area. Two courses were held in 2015, with a total of 62 participants: six of them were engaged by the hospital, and another 10 were ap-proved for employment when va-cancies arise.

Abrace ideias [Embrace ideas]: an apprenticeship program includ-ing basic training in creation, art, culture and informatics. It also covers concepts of sustainabil-ity, contributes to the develop-ment of skills, encourages new attitudes and prepares partici-pants for new challenges. It aims to introduce people to new social groups and job opportunities, and to produce entrepreneurs who are capable of changing the di-rection of their lives.


The program consists of two modules. Two groups completed the first module in 2015, with 12 people being trained. Four people are attending the second module, which is to end in May 2016.

Café com Chantilly [Coffee with Cream]: provides an space where people can think, socialize and ac-cept the difficulties and challenges of growing old. Three meetings were held in 2015, with a total of 203 participants.

Radiotherapy•The aim is to support the Fed-

eral District state health depart-ment to provide radiotherapy treatment for patients referred by the public healthcare system (SUS). 75 patients were treated in 2015. 61 of these completed their treatment and returned to the public clinics which had re-ferred them.

Breast cancerThis project has existed for more than 10 years, as a partnership be-tween Sírio-Libanês Hospital and the São Paulo City Administration. In 2015 more than 350 surgeries were carried out, more than 400 new cases were diagnosed and more than 15 thousand patients were seen by physicians and the multidisciplinary team.

There were also initiatives to im-prove the self-esteem of patients:

•Florescer [Blossoming]: meet-ings among patients and the multidisciplinary team aimed at demystifying the disease and encouraging people to keep up their treatment.

•De Bem com Você [At Ease with Yourself] – Beauty against Cancer: teaches beauty techniques and tips to women fighting cancer.

•Pre-surgery support group with nurses and psychologists.

•Donation of wigs, scarves, bras-sieres and external prosthesis.

Projects in consideration for BNDES loans

Due to its size, the Sírio-Libanês Hospital expansion program re-quired loans from both domes-tic and international financial institutions. In Brazil, the Brazil-ian Development Bank (BNDES) was one of the lenders. In return, it asked for 5% of the amount of the loan to be applied in projects supporting the SUS.

The partnership involves four initiatives aimed at helping to improve healthcare through pro-grams determined by the Minis-try of Health. Terms of reference for disseminating these guide-lines are agreed with the manag-ers, to meet healthcare demands more efficiently.


Sírio-Libanês Institute for Social Responsibility

(G4-26)

In addition to the support for Pro-adi/SUS, there are other projects aligned with the hospital’s philan-thropic mission. This significant assistance support for the SUS is provided by the Sírio-Libanês Institute for Social Responsibil-ity. As a separate legal entity, the institute manages state and municipal health services exclu-sively for SUS users. The projects underpin the commitment of the Sírio-Libanês Hospital to reinforce public healthcare in Brazil.

The institute was certified as a charitable organization in 2015, reinforcing its vocation as a pub-lic utility. Created to undertake projects in partnership with gov-ernment, it is recognized by the Municipality and the State of São Paulo as a social organization.

Partnerships with the São Paulo City Administration•The Menino Jesus Municipal

Children’s Hospital, in down-town São Paulo, offers low and medium-complexity pediatric treatment, chiefly for birth de-fects, with more than 20 medical specialties. In 2015, 60 thousand emergency cases and 72 thou-sand outpatients were treated, as well as 3 thousand patients in the day hospital, and 10 thou-sand tests were carried out.

•At the Santa Cecília Outpatient Clinic, in downtown São Paulo, patients can see physicians spe-cializing in seven areas of medi-cine, and nine types of diagnos-tic test are available. In 2015, specialists saw 69 thousand patients, and 18 thousand tests

were carried out.

•The Jardim Peri-Peri Outpatient Clinic, in the western zone of São Paulo, provides medical care for adults and children, without the need for appointments to be made, in cases of low and me-dium complexity. 63 thousand patients were seen in 2015.

•The Family Health Strategy (ESF) at the basic healthcare units in Cambuci, Humaitá and Nossa Senhora do Brasil, in São Paulo, focuses on the family and the conditions in which people live. The aim is to organize and integrate healthcare promotion and disease prevention initia-tives. 27 thousand people are registered. They can count on medical and nursing teams, and healthcare professionals visit their homes.

Partnerships with São Paulo State•The Grajaú General Hospital, in

the southern zone of São Paulo, provides medical and hospital care for urgent and emergency cases of medium to high com-plexity. It has has 268 beds, it is certified as a teaching hospi-tal and it offers internships for professionals from various areas of healthcare, as well as medi-cal residency and specialization courses. Key results in 2015 in-clude 261 thousand urgent cases seen, three thousand births and more than a thousand endosco-pies.

•The Jundiaí (SP) Regional Hos-pital specializes in medium-complexity cases and carries out elective (non-urgent) sur-gery. There are 120 beds and 16 intensive care units. More than

four thousand operations were carried out in 2015, as well as nearly 30 thousand appoint-ments with physicians and nurs-es, and 6 thousand tests.

•The Lucy Montoro Rehabilita-tion Service in Mogi Mirim (SP) offers state-of-the-art technol-ogy for treating patients with physical defects, incapacitating diseases and severe restrictions on mobility. The most significant results in 2015 were more than 4 thousand medical and 13 thou-sand non-medical appointments and 20 thousand therapeutic procedures.

•The Maria Cristina Cury Spe-cialties Outpatients Unit, in the southern zone of São Paulo, provides early diagnostic ser-vices and treatment in a number of different areas. There were 89 thousand medical and 49 thou-sand non-medical appointments in 2015, three thousand outpa-tient operations and seven thou-sand tests.

For more details about the in-stitute’s projects and results for 2015, please visit www.irssl.org.br.


The Sírio-Libanês Hospital seeks innovative ways of making infor-mation more transparent, encour-aging dialogue and exchanges with its strategic stakeholders, so as to engage them in the attain-ment of constant improvement in the offered services.

Transparency is guaranteed for the internal public, which consists of the multi-professional team (people working in the assistance, administrative and support areas) and the clinical staff, through par-ticipative forums and an intranet channel.

•Participative forums: opportuni-ties for discussion and interac-tion between staff, managers and officers. Examples are Talk-ing to the Corporate Superin-tendent meetings, Open Doors, the Extended Committee and Talking to the Managers meet-ings.

•An intranet portal, with man-agement tools allowing staff

to access training, assessment, research and other channels. The intranet includes Talk to Us, where staff can submit sug-gestions, criticisms and com-mendations, and ask questions, as well as reporting cases of discrimination, harassment and similar situations. No cases of discrimination were reported in 2015. The intranet also con-tains the People Management System (Sigep), which provides information on payrolls, training, miscellaneous surveys, internal recruitment and performance assessment, among other mat-ters. All institutional documents and rules can be accessed on the intranet.

For the external public, which includes patients, companions and others, the principal chan-nel available is the Ombudsman, which can be accessed from the hospital website. The Ombuds-man is also used to monitor the level of customer satisfaction with the services provided.

Relationship A range of online tools and relationship

channels offer greater transparency and dialogue with internal and external

stakeholders (G4-26, G4-57, HR2, HR3)

PROGRESS OF THE OMBUDSMAN OFFICE

20159,959 COMPLAINTS

9,825 COMMENDATIONS

20147,967 COMPLAINTS

5,895 COMMENDATIONS

PATIENT RECOMMENDATION INDEX (PR5)

2015

86%2014

87%


The following relationship mech-anisms and procedures are in place, in addition to the Ombuds-man:

•Suppliers: the Suppliers Rela-tionship Manual is available on the hospital website. It is based on ethics and transparency, and contains guidelines on the orga-nization’s purchases of goods and services.

•Press: the Press Relations Man-ual is intended as a guide for all press releases issued by the in-stitution. In addition, we have an area that takes care of our rela-tionships with the media (news-papers, magazines, websites, ra-dio/TV broadcasters, etc.).

•Government: since the Ministry of Health is our principal point of contact with government, through the social responsibil-ity programs, we have a spe-cific department for relations between SUS managers and the technical areas of the hospital.

•Scientific community: the Sírio-Libanês Education and Research Institute (IEP) submits the pa-pers produced by our staff for publication in domestic and in-ternational periodicals.

•Donors: a group of individuals and companies that contribute to the development of the insti-tution. Our Informação newslet-ter, with general news about the hospital’s performance, is sent to them on a regular basis.

TALK TO [email protected]

INFORMATION CENTER+55 11 3394-0200

INTERNATIONAL CALL CENTER

+55 11 3394-5520

MAILING ADDRESSHospital Sírio-Libanês.

A/C Ouvidoria. Rua Dona Adma Jafet, 91, Bela Vista, São Paulo (SP).

CEP 01308-000.

Focus on ethics

To ensure good interpersonal re-lationships and promote ethics and the search for excellence, the hospital has taken steps to dis-seminate our Code of Conduct more widely. To make the issues covered more transparent and to ensure that more people are aware of them, summaries are dis-played on boards in areas where a large number of people circulate. The hospital follows the guidelines of the Brazilian Federal Medical Council (CFM), which cover issues such as the relationship with pa-tients and family members, confi-dentiality, and professional rights and responsibilities.

The key challenges facing man-agement in 2016 relate to improv-ing communication about hospital ethics, providing better whistle blowing channels and quicker re-sponses to the staff, and encour-aging people to use the channel. A Bioethics Commission is also to be created, to meet demands from within the institution and from the market. (G4-57)

Patients’ Portal

The Patients’ Portal is one of our key relationship channels with this strategic public. It was in-troduced in 2008 and has been steadily improved since then.

The portal gives access to the re-sults of laboratory and imaging tests, clinical records (outpatient and inpatient treatment, drugs used and operations performed), updating of personal records and scheduling of tests and physi-cians’ appointments.


Physicians

Neighborhood

Competitors

Media

Scientific Community

SyndicatesSociety

Patients

Associates

Healthcare operators

Suppliers

Donors

Government

Staff

SÍRIO-LIBANÊS HOSPITAL

STAKEHOLDERS OF THE SÍRIO-LIBANÊS HOSPITAL (G4-24, G4-25)


Human capital

The main driving force of the Sírio-Libanês Hospital is its 5,975 employees working at the Bela Vista, Itaim, Jardins, Brasília Asa Sul and Brasília Lago Sul units. In addition, 910 outsourced staff

provide maintenance services for air conditioning and specialist equipment, the restaurant and the laundry, as well as providing some security and cleaning services.

Overview of people management (G4-10, LA1)

São Paulo Brasília

2013 2014 2015 2013 2014 2015

Gross payroll (R$ thousand) 264,798 324,094 373,424 2,821 4,139 6,275

Full-time staff 5,086 5,690 5,853 66 112 122

Temporary staff 34 65 29 3 1 2

Young apprentices 84 96 108 0 0 3

Interns 39 43 27 0 0 0

Outsourced staff 913 938 875 0 34 35

Number of employees by age (LA1)

Female Male

Age 2013 2014 2015 2013 2014 2015

< 30 years 1,005 21% 1,432 24% 1,098 18% 724 15% 830 14% 639 11%

31 to 50 years 1,755 36% 2,168 36% 2,455 41% 1,102 23% 1,279 21% 1,423 24%

> 51 years 141 3% 196 3% 210 4% 110 2% 131 2% 150 3%

Total 2,901 60% 3,796 63% 3,763 63% 1,936 40% 2,240 37% 2,212 37%


•Medical and dental care: 12,226 persons covered, including staff and their dependents

- Medical: free of charge for in-patients in general wards; in-patients who opt for a private room have to pay.

- Dental care: basic plan free of charge; payment for special plan.

- Medical and dental coverage: employee may include spouse and children (female employ-ees’ husbands pay the full cost).

•Tests: tests done in the hospital are covered for all staff and de-pendents included in the health-care plan (subject to payment of part of the cost, depending on use).

•Accredited drugstores: minimum discount of 15% for drugs, and promotional discounts may be as high as 55% (cost of purchases is deducted from payroll).

•Restaurant: varies from R$ 1.00 to R$ 3.29, according to salary level.

•Meal vouchers: R$ 18 for staff of external units, deducted from payroll monthly according to the number of working days, based on the refectory tariff and according to salary level.

•Food vouchers: R$ 156.03 (paid in double in December, corre-sponding to the amount for the month plus Christmas bonus).

•Group life insurance (free of charge to staff): coverage of 12,

BASIC BENEFITS FOR FULL-TIME STAFF (LA2)

24 or 36 times basic monthly salary, according to the position.

•Funeral expenses and assistance for staff and direct dependents (spouse and children): support during the process and cover-age of R$ 5,000 for funeral ex-penses.

•Travel vouchers as determined by law.

•Nursery costs or nursery allow-ance: R$ 184 for female staff with children.


In 2015 the hospital opened the Employees’ Outpatient Service, where employees can see general practitioners from Monday to Fri-day up to 10 p.m. The healthcare plan was also amended. The use of Mediservice is now post-paid instead of prepaid, which has generated savings for the organi-zation and has allowed the hospi-tal to teach its staff how to take preventive healthcare measures.

The adoption of a post-paid scheme helps reinforce the in-house healthcare network, focus-ing on primary care for outpa-tients and including dependents.

The changes to the plan were communicated in lectures and on the intranet, and a desk was manned in the administrative headquarters in the Bela Vista complex for people to ask ques-tions. A FAQ guide was also pub-lished.

The main program for promoting the health and well-being of the staff, Caring for Care Givers, was extended in 2015 and new spe-cialties were added. Currently it offers the possibility of perform-ing scheduled orthopedic sur-gery in the hospital (other than emergency or urgent treatment) and also cancer treatment. The program also includes numer-ous other initiatives to improve employees’ quality of life at work and elsewhere, such as teaching new eating habits, help with giv-ing up smoking, and support for pregnant women. All staff can also enjoy a range of sporting and cultural activities.

We have also extended the pro-gram to include scheduled neuro-surgery, oral maxillofacial surgery, bariatric surgery and immunobio-logical treatment. Additionally, all the staff have access to the hospital’s infrastructure and high--quality care, at no cost.

IN 2015, 225 EMPLOYEES WERE TREATED AT THE

SÍRIO-LIBANÊS HOSPITAL UNDER THE CARING FOR CARE GIVERS PROGRAM

Caring for Care Givers

2014 2015

Orthopedics

33 surgeries 116 surgeries

3 oral and maxillofacial surgeries indicated and confirmed

14 oral and maxillofacial surgeries indicated and confirmed

Bariatric Oncology 21 patients with cancer 32 patients with cancer

Bariatric surgeries 3 procedures performed 14 procedures performed

Complex cases (heart surgery, pediatric ICU, high-complexity procedures)

15 patients 47 patients

QUALITy OF LIFEOne innovation in 2015 was the opening of a functional training studio, with activities such as yoga and dancing, at the Buil-ding E. The Employee Commu-nity Center is located on the same floor, with a TV room, rela-xation area, cafeteria and veran-da, offering employees a better quality of life.

3,763 WOMEN WERE EMPLOYED BY THE ORGANIZATION IN

2015. SOME 70% OF MANAGEMENT POSITIONS WERE

HELD By WOMEN, THE SAME PERCENTAGE AS

IN 2014


Turnover (LA1)

Female Male

2014 2015 2014 2015

Without increase in staff numbers 1.33% 1.16% 1.24% 1.16%

With increase in staff numbers 1.20% 1.41% 0.98% 1.42%

Comparison of numbers of leavers (total and percentage) (LA1)

Idade

2014 2015

Female Male Female Male

< 30 years 274 33% 195 23% 232 27% 177 20%

31 to 50 years 220 26% 129 16% 277 32% 153 17%

> 51 years 8 1% 6 1% 26 3% 10 1%

Total by gender 502 60% 330 40% 535 61% 340 39%

< 30 years 31 to 50 years > 51 years

2014 2015 2014 2015 2014 2015

Without increase in staff numbers 2.10% 2.75% 0.85% 1.17% 0.28% 0.56%

With increase in staff numbers 1.67% 3.45% 0.82% 1.59% 0.32% 0.73%

Hires (LA1)São Paulo Brasília

2014 2015 2014 2015

Age Female Male Female Male Female Male Female Male

< 30 years 437 198 404 252 18 11 7 6

31 to 50 years 459 182 294 146 16 7 7 2

> 51 years 11 4 3 6 0 1 0 0

Total by gender 907 384 701 404 34 19 14 8

Total 1,291 1,105 53 22


Retention of talents

Our policy for attracting and re-taining talents is intended to en-sure that the best of our human capital remains with the institu-tion. To keep these professionals engaged and promote their de-velopment, people management programs and policies have been introduced to give priority to employees’ career development, satisfaction, commitment and recognition.

Some special measures were tak-en in 2015 to retain staff:

•The reformulation of the assis-tance model created an oppor-tunity to absorb more nursing technicians as nurses after their graduation. The importance of developing management skills was reinforced in the nursing residences. The percentage of nurses engaged rose substan-tially in 2015, from 25% to 38%. Nursing residents have the chance of training and being taken on to the full-time staff,

Parenting leave (LA3)

2014 2015

Staff who took parenting leave 132 177

Staff returning to work after parenting leave 125 159

Staff returning to work after parenting leave and still with the company 12 months later 105 106

Rate of utilization¹ 4% 5%

Rate of return² 95% 90%

Rate of retention3 89% 80%1. Number of staff taking parenting leave / number entitled to leave. 2. Number of staff returning to work after parenting leave / number taking leave. 3. Number of staff returning to work after parenting leave and still with the company 12 months later / number taking leave.

with a salary increase, within 2 years.

•Continuance of study groups for nursing specialties, an advanced skills program which is optional. The program includes time for learning to care for the elderly, the use of catheters and other functions. A reserve of special-ists is created out of the group, which means better service and support for overall operations.

Qualification and training

In 2015, we took steps to con-solidate management by skills. Selection processes, training and assessment are based on a skills model developed exclusively for the Sírio-Libanês Hospital. The profile includes institutional, lead-ership, assistance and administra-tive/support skills.

To monitor the stage of develop-ment of each member of the staff, each year we assess performance

and individual development plans (PDI). The first stage consists of self-assessment; subsequently, the manager and the employee meet to talk and reach a con-sensus for constructing the PDI. (LA11)

In addition to the five recognition programs already in existence (Celebrate the Team, My Worth, Seniority, Employee Innovation Center and ELO), the Multi Cele-brate the Team program has been introduced, to encourage the culture of recognition even more by commemorating multi-profes-sional team projects and deliver-ies. 12 teams, consisting of 463 employees, participated in the celebrations in 2015. (DMA, LA10)


Training (LA9) 2014 2015

Investment R$ 5 million R$ 5 million

Hours of training 220,577 210,905

Hours of training per employee per month 3.54 3.16

Man hours of training (LA9)

Category2014 2015

Women Men Women Men

Managers 3.84 3.15 5.10 3.30

Nurses 3.81 3.04 6.80 7.30

Nutritionists 6.35 2.52 13.50 4.40

Pharmacists 5.38 4.53 8.80 11.60

Physiotherapists 3.16 2.78 4.70 6.40

Nursing auxiliaries and technicians 2.86 2.72 7.70 9.90

Physicians 0.98 0.77 0.80 0.60

Biomedics 1.25 1.14 2.30 1.90

Other professionals 1.73 1.44 2.00 1.40

Study scholarships granted (for training courses) (LA10)

Program 2014 2015

Master’s degree in healthcare technology and innovation management (IEP) 3 3

External graduate studies 44 35

Graduate studies (further studies and specialization at the IEP) 50 31

Bachelor’s degree in hotel management 2 2

Professional technical course (nursing, pharmacy, accommodation and accounting) 22 19

Languages (English and Spanish) 243 196

Total 364 286


InclusionIn 2015, the Mais Inclusão [More In-clusion] program, which promotes employment for disabled people (PCDs), makes it possible to train staff in-house through a partner-ship between the People Manage-ment and Philanthropy superinten-dences.

To execute the program, the hos-pital has developed a pilot scheme called Cidadania Ativa [Active Citi-zenship], under which 15 disabled people were engaged and given six months of training in admin-istrative techniques (theoretical classes, with internships on the hospital). As a result, these people are better adapted and monitored, and 80% of those trained were of-fered jobs.

MULTIPROFESSIONAL TRAINING CENTER (LA10)

Training is an important strategy for staff development to ensure that patient care is safe and of good quality.

The Multi-professional Training Center was opened in 2015. It takes up a full floor, and is aimed at enhancing and updating the skills of the multi-professional te-ams. Using active methods such as realistic simulations, it is pos-sible to reproduce routine hospi-tal situations for different jobs or operating areas.

The center has a suite equipped exactly as an inpatient unit in the hospital, with furniture, equip-ment and lifelike models using

advanced technology – their blood pressure, pulse and body temperature can be measured, and access for administering drugs is possible through their

“veins”.

There are other multipurpose rooms, which can be arranged according to training needs, equi-pped with audio and video sys-tems, so that staff in other parts of the hospital can watch the procedures performed. It is thus possible to involve staff of diffe-rent areas for the exchange of ideas and for learning and deve-lopment.

The training covers subjects inclu-ding emergency treatment, han-dling of drugs, changing dressin-gs, cleaning rooms, physiotherapy and nutritional treatment.

We also have our Protected Work-shop, which employs 13 people with mental handicaps to carry out tasks such as assembling educa-tional kits and typing tax receipts.

At the end of 2015 we had 215 dis-abled employees on the payroll, corresponding to 72% of the quota for the institution.

young Apprentice

The program, which provides the-oretical and practical training for young people, attracted 105 par-ticipants in 2015. They work in a number of different areas of the hospital, and 32 were taken on in administrative positions.

Health and safety

Staff healthcare management is based on four premises:

•Recognizing the dangers and risks existing in the work envi-ronment and activities, and the state of health each employee needs to maintain;

•Telling the employee about the state of health identified;

•Training staff to deal with these dangers and risks and with their own biopsychosocial character-istics;

•Helping staff when their health deteriorates.

To satisfy these premises, we combine occupational medicine, occupational safety engineering, quality of life, psychology and so-cial services. Each of these areas has a specialist responsible for ac-tion taken and for integration be-tween the different areas.


Improvements have been made in this area, and the institution has been granted the OHSAS 18001 certificate, which relates to occu-pational health and safety issues. The hospital was also awarded the AnimaSeg Prize for occupa-tional health and safety, following a recommendation by the Brazil-ian National Association of Pri-vate Hospitals (ANAHP).

In addition to preparing to obtain the certificate, we hold annual prevention and awareness cam-paigns organized by the Internal Accident Prevention Commission (CIPA). The CIPA’s function is to prevent accidents, report inci-dents, persuade staff to adopt

Training on employees’ health and safety (LA5)

Program Employees trained Hours of training

NR 35 53 504

NR 10 33 1,160

NR 32 (distance learning)2,518 full-time 2,518

95 outsourced 95

Radioprotection 415 698

Fire brigade (off-site)447 full-time 3,194

35 outsourced 280

Refresher course for brigade members 344 1,032

Fire brigade (distance learning)2.313 full-time 121

121 outsourced 2,313

Occupational accidents (LA6)Bela Vista Itaim Jardins Brasília

2014 2015 2014 2015 2014 2015 2014 2015

Frequency ratio 17.68% 27.54% 8.8% 44.35% 20.49% 15.99% 0% 19.97%

Seriousness ratio 21.74% 66.42% 27.88% 66.53% 0% 31.98% 0% 71.88%

Man hours worked (HHT) 13,797,844 11,111,791 681,540 360,744 48,800 62,533 214,380 250,419

Number of accidents 244 306 6 16 1 1 0 5

Number of days lost 300 738 19 24 0 2 0 18The institution sets targets for occupational accidents on the basis of the frequency ratio recommended by the International Labor Organization (ILO). Frequency ratio = (No. of accidents/HHT) x 1,000,000. Seriousness ratio = (No. of days lost/HHT) x 1,000,000. HHT = man hours worked. No deaths were recorded in 2014, in any of our units.

good occupational health and safety practices, carry out inspec-tions and organize and publicize Internal Occupational Accident Prevention Week (SIPAT).

The chairman and vice chairman of the CIPA are members of the Institutional Safety Committee, representing all the staff. CIPA members are elected annually, online, so that employees can use their personal passwords se-curely, and this makes it quicker to obtain the percentage of votes provided for in Regulatory Ordi-nance No. 5 (NR 5).

In 2015, training was provided for staff of the organization (full-

time, temporary and outsourced employees) under the applicable ordinances (NR 5 and NR 32 of the Ministry of Labor), and peri-odic inspections and audits were carried out to ensure good ergo-nomic, environmental and safety conditions. (LA5)

Another important mechanism is the measurement of risk in the hospital, to improve the safety of patients and others. This is done under the institutional safety plan. The plan includes monitor-ing, reporting and control. (DMA)


Our suppliers are an important part of the Sírio-Libanês Hospital management system, and they are instructed to observe the good practices that contribute to the quality of the medical and hospital service and to the sustainability of the entire production chain.

The Supplier Relations Manual serves this purpose, containing rules and standards of conduct required, with items related to prevention of labor analogous to slavery and child labor, and to the appreciation of diversity. The doc-ument also sets technical quality requirements, legal and sanitary standards, occupational health and safety rules and rules for re-spect for the environment, all of which are necessary for a supplier to be approved by the hospital.

A technical assessment is per-formed for all suppliers of prod-ucts and services submitting quotations for purchases. For suppliers of materials, drugs and OPME, the technical quality stan-dards of the Supplier Assessment Group (consisting of pharmacists from the institution and partner hospitals) are applied. The other groups (nutrition, hygiene, clinical engineering etc.) use the quality criteria defined by the manager and the team responsible for the sector.

Multi-professional technical com-missions help approve inputs: they are the Pharmacy and Therapeutic Commission (CFT) and the Mate-rials Standardization Commission (CPM). CFT meetings discuss the selection of drugs and the prac-

tices for their use in the hospital. The CPM assesses the standard-ization of new disposable material requested by the teams and ap-proves new brands as commercial alternatives or to replace products unavailable in the market.

Technology to assist management

We use special electronic trading platforms as a way to ensure that the process of quoting for and purchasing inputs is efficient and transparent. For purchasing spe-cial materials (OPME) we use the Inpart Saúde system, which also controls and manages the legal and health documentation. Other hospital inputs are purchased on the Bionexo system.

For planning purchases of stan-dard stock items we use a special software called GTPlan, which ap-plies smart statistical methods that can identify ideal purchasing periods, inventory flows and de-mand, and other important trends for optimizing the process. The system also provides for accred-iting suppliers, ranking them ac-cording to a points system.

We also constantly assess suppli-ers of inputs and services. Hos-pital materials, drugs and other products are monitored from the time of receipt, with an automatic check on the estimated and actual delivery dates, and an electronic checklist of transportation and storing conditions. The assess-ment provides a final mark, which is used as a criterion for extending relations with a supplier.

Suppliers (G4-12, G4-26)

Category Number of suppliers Responsibilities

Products 776

To provide products such as hospital materials and drugs; orthotics, prosthetics and special materials (OPME); fixed assets and other material for consumption, in line with fixed, documented technical standards

Services 1,332

To supply/provide maintenance, consultancy, security, cleaning, construction, education and research and transport services, etc., in line with fixed, documented technical standards.


Quality and safety standards

Our vigilance extends to the per-formance and efficacy of drugs, and to any adverse effects de-tected that may be harmful to the health of patients or staff, accord-ing to the best pharmaceutical and technical vigilance practices, such as the Hospital Sentinela [Sentinel Hospital] of the National Health Surveillance Agency (An-visa).

Service providers must meet the contractually defined technical criteria for quality – as provided for in the service level agreement (SLA) and in the requirements for the ISO 14001 and OHSAS 18001 certifications. To meet our com-mitment to preserving the envi-ronment, and to the health and safety of our staff, we systemati-cally assess suppliers with larger numbers of workers that create a greater environmental impact. To this end, annual audits are per-

Supply chain’s volumetry 2014 2015

Drugs

No. of suppliers 170 171

Purchase volumes R$ 137,960,648.79 R$ 155,143,424.05

Days inventory (imports) 22 20

Materials



Days inventory (imports) 39 37

OPMENo. of suppliers 206 224


Total



Days inventory (imports) 25.4 24.0

HOSPITAL’S SUPPLy CHAIN

Supplier

Hospital logistics

Multidisciplinary care

Suppliers Qualification Method

(GAFO)

Demand planning system

- GTPlan

B2B electronic healthcare

trading - Bionexo

Suppliers assessment

system - GTPlan

Delivery bay management

system

Robotic automation - Swisslog

Temperature control - Incoterm

Electronic dispensaries - CareFusion

Pneumatic transport - Aerocom

Traceability of the chain – bar code and RFID tag

Industry

Qualification of suppliers

Hospital

Distributor

Standardization of products

Demand planning

Unitization and labeling

Dispensing/ distribution

Storage

Physician’s prescription

Pharmaceutical care

Nursing care

Purchase Receipt

formed to constantly check and monitor all the supporting docu-mentation.


The concept of sustainability in the hospital is applied to a range of work areas, from the qual-ity and safety of care to financial soundness, via minimization of social and environmental impacts.

The institution holds the globally recognized ISO 14001 certificate for environmental management, which we obtained in 2015. We are also applying for a LEED Gold certificate, granted by the U.S. Green Building Council for build-ings aligned with criteria for the efficient use of water and energy, innovation in equipment and proj-ects, and the quality of the air. The first results of the technology used in the new buildings in the Bela Vista complex started to be collected in 2015, to use for the LEED application.

We also use benchmarks such as the Global Agenda for Green and Healthy Hospitals, devel-

oped by the Healthy Hospitals network to support worldwide initiatives for sustainability and respect for the environment in the healthcare sector. The agenda is based on ten interrelated prin-ciples, aimed at reducing envi-ronmental impacts, such as those produced by waste and inputs. Work is currently in progress to meet all the proposals, as follows:

(G4-15)

•Leadership: prioritize environ-mental health

•Chemical substances: replace dangerous substances with safer alternatives

•Waste: reduce and treat waste, and dispose of it safely

•Energy: implement energy ef-ficiency and generate clean, re-newable energy

•Water: reduce water consumption and provide drinking water

•Transport: improve transport strategies for patients and staff

•Food: purchase and supply healthy food, produced sustain-ably

•Pharmaceutical products: appro-priate prescription, safe manage-ment and correct destination

•Buildings: support projects and construction of green, healthy hospitals

•Purchases: buy safer, more sus-tainable products and materials.

Environmental management

In addition to its certifications, the Sírio-Libanês Hospital uses global benchmarks

for sustainability and respect for the environment in the healthcare sector, seeking

to innovate through the best practices and use of technology to reduce impacts

(G4-15, G4-26, DMA, EN31)


The complex activities within the hospital produce impacts of vari-ous kinds. One of them is generat-ing different types of waste. To re-duce this volume and ensure that waste is disposed of appropriately and recyclable material reused, a total of R$ 1.5 million was invested in 2015.

The hospital has made efforts to involve and commit its staff, sup-pliers and other people directly involved in its operations, so as to minimize environmental impacts. One of the points of attention for improvement is the way that indicators are communicated. Al-though information is available on the intranet, awareness and envi-ronmental initiatives do not en-gage many people in the hospital. The Sustainability Committee dis-cusses these and other matters at its monthly meetings, to acceler-ate its transdisciplinary activities.

Waste management

During 2015, the hospital pro-duced 9.4 tons of waste per day, 9% more than in 2014. The indica-tor is within expected parameters for an institution of our size, and includes waste from the admin-istration areas, support services and hospital activities – the last of which produce the largest and also the most hazardous portion.

In 2015, we made progress with the paperless concept, which calls for the eradication of the use of paper in hospital process-es, and lower use of material and production of waste. Savings are expected when printing is no lon-ger necessary. (DMA)

Quantity of waste generated and disposal in 2015 (EN23, EN25)Waste 2015 Destinação

Infectious 694 t ETD (electrothermal deactivation)

Common 1,422 t Sanitary landfill at Rodovia dos Bandeirantes, km 33 (Caieiras, SP)

Radiotherapy 0.233 t ETD (electrothermal deactivation)

Hazardous chemicals 57 t Essencis Soluções Ambientais Ltda.

Recyclable* 342 t

Cardboard and paper - GTF Papéis (SP) Plastic (polyethylene) – Nova Reciclagem Miscellaneous plastic (other than polyethylene) - Aplascon Metal and glass - Valdomiro Dias ME

Organic (compost) 896 t Biomix Indústria e Comércio de Insumos Orgânicos Epp

Perforating and cutting 46 t ETD (electrothermal deactivation)

Electronic 4 t Settaport FoundationData is collected only at the Bela Vista unit.

*Includes: cardboard, paper, plastic, metal, glass, aluminum, fluorescent bulbs, batteries, X rays, cooking oil and styrofoam.

PNEUMATIC TRANSPORT OF WASTE

After installing a vacuum (pneu-matic) system for transporting dirty clothing and common waste in the new tower (Building D), the Sírio-Libanês Hospital became a pioneer in the use of this advan-ced technology. In this way, col-lection of hospital waste and dirty clothing is quicker and safer, with no human handling, and this cuts the risk of infection and increases the safety of staff and patients.

Recycling (in tons) 2013 2014 2015

Cardboard* 139 166 199

Paper 50 35 49

Plastic 34 55 70

Metal 10 8 9

Glass 8 8 9.8

Aluminum 3 3 2.7

Batteries - 0.400 0.449

X rays - 0.350 0.436

Styrofoam - 0.750 2

Bulbs treated (units) 2,128 13,855 12,147

*Includes material intended for the Trash Pickers proj-ect. A total of 160 tons was donated in 2015 (more information in the sub-chapter Value for the Com-munity).


Water consumption management

The Sírio-Libanês Hospital has a diverse matrix of water sources, with supplies from Sabesp, arte-sian wells and water trucks.

In 2015, our strategy was to make progress with managing this re-source. Some measures have been in place since 2014, such as the in-stallation of equipment to limit the flow of water in taps, and new eco-nomical discharge valves, as well as more efficient showers, basins and taps. Teams monitor waste, and we shall very soon have on-line management of consumption, which will enable us to identify problems and act immediately.

The Waste Treatment Station (ETE) and the Rainwater Treat-ment Station (ETA) continue to produce good results, providing some 2 thousand m³ per month, or 10% of our reused water.

One of the highlights of water management in 2015 was the in-troduction of a water safety plan (PSA), focusing on risk manage-ment, which many countries con-sider to be the right method to comply with rules for water qual-ity, especially in care environments. (DMA, EN10, EN22)

In 2015 we achieved our target of cutting water consumption by 15%, even with a substantial increase in installed capacity.

Water consumption per m²

2013 2014 2015 2015 x 2014

2.94 2.68 1.61 -40%

Water consumption (in thousands of m³) (EN8)

Source 2013 2014 2015 2015 x 2014

Sabesp* 178 177 80 -55%

Artesian well 73 70 85 22%

Water truck 20 45 64 41%

Reuse 0 4 22 450%

Total 270 296 251 -15%*In Brasília, water is supplied by Caesb (Companhia de Saneamento Ambiental do Distrito Federal). All effluent waste is disposed of through the local sewage system (Sabesp or Caesb). (EN9)


Energy consumption

To reduce the consumption of electricity, the Sírio-Libanês Hos-pital has made progress in iden-tifying and using new lighting systems. The changeover of con-ventional lighting to LED started in 2015 and will continue during 2016. The new towers use 100% efficient energy, which is up to 75% more economical than con-ventional systems.

Automatic management of the cold water system (CAG) using automation and building man-

Energy consumption inside and outside the organization (EN3, EN4)

2013 2014 2015

Biodiesel (in liters)¹ 50,782 22,000 307,110

Electricity purchased (in millions of KWh)² 33 35 37

Natural gas (in thousands of m³) 243 297 3321. Used exclusively in the generators. 2. The electricity concessionaires supplying the healthcare units are AES Eletropaulo (in São Paulo) and Companhia Energética de Brasília (CEB), in the federal capital.

Consumption of energy* in megajoules (MJ) per m2 (EN5)

2013 2014 2015 2014 x 2015

1,389 1,247 959 -23%*includes all energy generation sources

agement will reduce energy con-sumption by around 15% as from the first quarter of 2016.

Another project is focused on identifying variations in electri-cal power levels and stabilizing them. This is a new idea in Bra-zil, but already in use in countries such as England, and can reduce energy consumption by around 10%. (DMA, EN6)


Emission of gases

After the expansion of capacity in the hospital, emissions of CO2 fell in absolute terms between 2014 and 2015, partly due to a re-duction in the consumption and purchase of electricity, especially when we consider the increase in working area with the opening of the new towers.

To cut emissions from the hospi-tal supply chain, we use software that controls the entry and exit of vehicles. The system, which is now operating, records the type of vehicle, its origin and its pur-pose, and allows emissions to be

calculated more accurately. The information produced can assist action to improve the flow, such as encouraging people to replace old cars with newer ones. We are planning to find new ways of en-gaging suppliers in the use of bio-fuels, offering them incentives to make the change.

In 2015, we started to use a bio-fuel system in the electricity sup-ply plant (located in the Bela Vis-ta complex), and it is now using 70% of natural gas and only 30% of commercial diesel oil, which is partly composed of biodiesel

Emissions of CO2 equivalent (in tons) (EN15, EN16) 2013 2014 2015 2015 x 2014

Scope 1

Static and mobile combustion 857 731 1461 100%

Air conditioning and nitrous oxide 6,638 6,724 4,560 -31%

Scope 2

Electricity purchased and consumed 3,162 4,742 4,585 -3%

Total of scopes 1 and 2 10,657 12,197 10,606 -13%

Scope 3 (all other sources) 219 223 410 84%

GRAND TOTAL 10,876 12,420 11,016 -11%

Intensity of emissions of CO2 equivalent (EN18)

2013 2014 2015 2015 x 2014

0.12 0.11 0.07 -37%

(previously, 100% of consumption was commercial diesel oil). This initiative, a pioneer among Bra-zilian hospitals, has had a major environmental impact. The new air conditioning system has also reduced emissions significantly. (DMA)

The hospital has been a subscriber to the GHG protocol since 2012, and this year it adhered to the gold seal granted to organizations that submit their inventories to independent external verification. (G4-15).


We started 2015 with a very con-servative budget, considering the economic situation and the con-traction of the market. We con-centrated more on the comple-tion of our expansion plan and the new investments, and on the impact of both increased demand and of the expected results of opening the new towers in the Bela Vista complex. At the same time, we improved the quality of service offered, through qualified professionals and more people on the clinical staff.

We analyzed the behavior of the economy and the realization of revenues and expenses, and de-cided that our strategy should be not to make any more beds avail-able during 2015 or 2016. Propos-als were made to maximize the institution’s results, such as nego-tiating better average terms for payments and receipts. The long-term strategy and budgets were also integrated, to give more ac-curate forecasts and contribute to financial sustainability.

Management efforts in differ-ent areas of the organization led to overshooting our target for the year’s results: we had fore-cast R$ 173 million and achieved R$ 177 million. These efforts also brought us greater numbers of patients, which generated enough cash to support the decision not to make more beds available. Building C was partly closed for refurbishment, which temporarily cut its structural costs, since the patients were concentrated in the other units.

The new tower has the potential to enable us to hire more staff, to apply more funds to philanthropy and to increase the number of indirect jobs. In addition, since the building is constructed and operated according to criteria of respect for the environment, we expect that it will enable us to obtain the LEED Gold certificate, issued by the U.S. Green Building Council, and this should give us exemption from the property tax (IPTU) payable to the São Paulo city council.

Our figuresThe emphasis on managing the budget, introducing new tools to enhance the

management of resources and an effective productivity project enabled us to exceed

the forecast result

INVESTMENT IN CASH REGIME (2009 TO 2015)

R$ 1.2 bi


To improve the management of our financial resources, we are changing the budget process in 2016 and in the future we will use a special tool called Prophix. This should provide better quality in-formation and improve synergy between departments, helping the Board of Directors to guide the company and take decisions. Once trained in the use of the integrated system, the managers can evalu-ate the impact of their actions and their contribution to the results of the organization. This is how we plan to proceed in 2016: with the necessary caution, investing little and, subsequently, reconsidering more investment as from 2017.

In 2015, we depended on the Strategy and Finance Committee to redirect our financial efforts, ra-tionalizing costs and reassessing investments. The Board of Direc-tors put productivity on its agen-da: this affected the entire chain of care in the institution and led to a review of hospital procedures. As an example, one of the most significant results was in the nurs-ing area. The operating model was given a broader outlook, taking into account the overall situation of occupancy in the hospital, day by day, thus enabling more effec-tive choices to be made in the use of the available structure and staff, to provide better care for the pa-tients. The resource pool resulting from the staff reorganization was expanded in 2015, improving the hospital’s productivity indicators and creating economies of scale for the institution.

KEy SOURCES OF REVENUE

74% DOMESTIC HEALTH INSURANCE PLANS

24% PRIVATE PATIENTS

2% INTERNATIONAL

HEALTH OPERATORS

Statement of income for the year 2015 (G4-EC1)

Statement of income¹ 2015 2014

Operating revenues 1,346,958 1,174,027

Cost of drugs, materials and medical services (358,731) (319,172)

Gross surplus 988,227 854,855

Operating expenses

Personnel costs and charges (463,524) (396,873)

Depreciation and amortization (43,194) (37,011)

Administrative and general expenses (299,222) (292,780)

Other operating expenses, net (48,736) (12,796)

Total (854,676) (739,460)

Operating surplus before financial result 134,402 115,395

Net financial expenses (47,344) (1,473)

Surplus for the year 86,207 113,922 1. In thousands of Reais

The above financial statements are for all the units (Bela Vista, Itaim, Jardins and Brasília - Asa Sul and Lago Sul).

Performance in 2015

The results for the year cover the period from January 1 to Decem-ber 31, 2015. In spite of the pre-operating expenses of the plan to bring the new towers into op-eration, and the country’s eco-nomic difficulties, the institution performed well during the year. EBITDA amounted to R$ 177 mil-lion, with a 13.1% margin.


The 2015 Sustainability Report contains information for the pe-riod from January 1 to December 31, 2015, showing the financial and operating results, manage-ment and corporate governance, and the social and environmental performance of the institution, as well as its impact on society.

The document, which has been published each year since 2008, is intended to provide a trans-parent account of the strategies, actions and performance of the Sírio-Libanês Hospital. In 2014, we revised the base for our stake-holders, identifying new ones and prioritizing some of them for consultation during the material-ity process. The base for material issues was reviewed in the same year. We cross-referenced the re-sults of the impact dynamic un-dertaken with the hospital man-agement against an analysis of sector studies and internal docu-ments of the organization. Issues are given priority on the basis of the results of a panel set up in 2014, which included members of the surrounding community and representatives of our sup-pliers; and the results of an online questionnaire sent to managers, the clinical staff, employees, third parties and patients, and of inter-views with specialists.

Managers and senior staff of the Sírio-Libanês Hospital took an active part in drafting the re-port, and the technical teams were responsible for collecting and analyzing data. There are no significant changes in scope or

in information from the previous edition of the report, for the year 2014.

This report has been prepared according to the Global Report-ing Initiative (GRI) G4 guidelines, Core reporting scope. The finan-cial and non-financial information has been verified by the audit firm KPMG.

The report includes details of the strategies, initiatives, products, services, projects, operations and business of the units in São Pau-lo (Bela Vista, Itaim and Jardins) and in Brasília (Asa Sul and Lago Sul), all of which are also included in the financial statements shown in this report.

Information and limitations on specific GRI indicators are shown in the GRI index (after the audi-tor’s opinion) or throughout the text. Queries, criticism and sug-gestions about the content may be emailed to us at [email protected]. Our website www.hospitalsiriolibanes.org.br gives information about previous reports.

(G4-17; G4-18; G4-22; G4-23; G4-25; G4-26; G4-28; G4-29; G4-30; G4-31; G4-32; G4-33)

About the Report


Summary of GRI Content

GENERAL CONTENTS

Description Chapter / response External verification

Strategy and analysis

G4-1 Message from the CEO 04 yes, page 87

Organizational profile

G4-3 Name of the organization 14 yes, page 87

G4-4 Primary brands, products and/or services 14 yes, page 87

G4-5 Location of organization’s headquarters 14 yes, page 87

G4-6 Countries with either major operations or that are specifically relevant to the sustainability issues covered in the report

17 yes, page 87

G4-7 Nature of ownership and legal form 14 yes, page 87

G4-8 Markets served 17 yes, page 87

G4-9 Scale of the reporting organization 17 yes, page 87

G4-10 Profile of the employees 17 yes, page 87

G4-11 Percentage of total employees covered by collective bargaining agreements All the full-time staff yes, page 87

G4-12 Description of the organization’s supply chain 70 yes, page 87

G4-13 Significant changes regarding size, structure, ownership and supply chain 14 yes, page 87

G4-14 Explanation of whether and how the precautionary approach or principle is addressed by the organization 24 yes, page 87

G4-15 Charters, principles or other external initiatives 29, 72, 77 yes, page 87

G4-16 Membership in associations and organizations

Sírio-Libanês is a member of the National Association of Private

Hospitals (Anahp), which represents the main hospitals in the country.

yes, page 87


Description Chapter / response External verification

Identified material aspects and boundaries

G4-17 Entities included in the consolidated financial statements and any not covered in the report 81 yes, page 87

G4-18 Process for defining report content 11, 81 yes, page 87

G4-19 List of material aspects 12 yes, page 87

G4-20 Boundary, within the organization, for each material aspect 12 yes, page 87

G4-21 Boundary, outside the organization, for each material aspect 12 yes, page 87

G4-22 Reformulation of information provided in previous reports 81 yes, page 87

G4-23 Significant changes from previous reporting periods in scope and aspect boundaries 81 yes, page 87

Stakeholder engagement

G4-24 List of stakeholder groups engaged by the organization 11, 61 yes, page 87

G4-25 Basis for identification and selection of stakeholders with whom to engage 11, 61 yes, page 87

G4-26 Approaches to stakeholders’ engagement 18, 20, 25, 31, 32, 33, 39, 40, 44, 53, 57, 59, 67, 70, 72, 81 yes, page 87

G4-27 Key topics and concerns raised through stakeholders’ engagement, by group of stakeholders 11 yes, page 87

Report profile

G4-28 Reporting period 81 yes, page 87

G4-29 Date of most recent previous report 81 yes, page 87

G4-30 Reporting cycle 81 yes, page 87

G4-31 Contact point for questions regarding the report or its contents 81 yes, page 87

G4-32 Option for applying guidelines and location of the GRI table 81 yes, page 87

Governance

G4-33 Policy and current practice with regard to seeking external assurance for the report 81 yes, page 87

G4-34 Governance structure of the organization 20 yes, page 87

Ethics and integrity

G4-56 The organization’s values, principles, standards and norms of behavior 14 yes, page 87

G4-57 Internal and external mechanisms for seeking advice on ethical and lawful behavior 60 yes, page 87


SPECIFIC CONTENT

Description Page / response Omission External verification

Economic category

Aspect: Economic performance

G4-DMA Form of management 80 – yes, page 87

G4-EC1 Direct economic value generated and distributed 80 – yes, page 87

Aspect: Indirect economic impact


G4-EC7 Impact of investments in infrastructure made for the public benefit 39 – yes, page 87

G4-EC8 Description of significant indirect economic impacts 39 – yes, page 87

Environmental category

Aspect: Energy


G4-EN3 Energy consumption within the organization 76 – yes, page 87

G4-EN4 Energy consumption outside the organization 76 – yes, page 87

G4-EN5 Energy intensity 76 – yes, page 87

G4-EN6 Reduction of energy consumption 76 – yes, page 87

Aspect: Water


G4-EN8 Total water withdrawal by source 75 – yes, page 87

G4-EN9 Water sources significantly affected by withdrawal of water 75 – yes, page 87

G4-EN10 Percentage and total volume of water recycled and reused 75 – yes, page 87

Aspect: Emissions


G4-EN15 Direct greenhouse gas emissions 77 – yes, page 87

G4-EN16 Indirect greenhouse gas emissions from acquisition of energy 77 – yes, page 87

G4-EN18 Intensity of greenhouse gas emissions 77 – yes, page 87



Aspect: Effluents and waste

G4-DMA Form of management 74, 75 – yes, page 87

G4-EN22 Total water discharge by quality and destination 75 – yes, page 87

G4-EN23 Total weight of waste by type and disposal method 74 – yes, page 87

G4-EN25 Weight of hazardous waste transported 74 – yes, page 87

Aspect: Overall


G4-EN31 Total environmental protection expenditures and investments 72 – yes, page 87

Social category – labor practices and decent work

Aspect: Employment


G4-LA1 Total number and rates of new employee hires and employee turnover 62, 65 – yes, page 87

G4-LA2 Comparison of benefits for full-time and temporary employees 62 – yes, page 87

G4-LA3 Return to work and retention rates after parental leave, by gender 66 – yes, page 87

Aspect: Occupational health and safety


G4-LA5 Percentage of total workforce represented in formal health and safety committees 69 – yes, page 87

G4-LA6 Rates of injury, occupational diseases and lost days 69 – yes, page 87

Aspect: Training and education


G4-LA9 Average hours of training per year 67 – yes, page 87

G4-LA10 Programs for skills management and lifelong learning 66, 67, 68 – yes, page 87

G4-LA11 Percentage of employees receiving performance reviews 66 – yes, page 87



Social category – human rights

Aspect: Investment


G4-HR2 Total hours of employee training on human rights policies and percentage of employees trained 59, 67 – yes, page 87

Aspect: Non-discrimination


G4-HR3 Total number of incidents of discrimination and corrective actions taken 59 – yes, page 87

Social category - society

Aspect: Local communities

G4-SO2 Operations with significant actual or potential negative impacts on local communities

The surrounding community does not

consider matters such as waste and noise/

transport as having an impact, according to a survey of stakeholders undertaken during the process of reviewing materiality for this

report.

– yes, page 87

Aspect: Anti-corruption

Social category – product responsibility

Aspect: Customer health and safety


G4-PR1 Assessment of health and safety impacts during the life cycle of products and services 24, 32 – yes, page 87

G4-PR2 Incidence of non-compliance concerning the health and safety impacts of products and services 24, 25 – yes, page 87

Aspect: Product and service labeling

G4-DMA Form of management 33, 59 – yes, page 87

G4-PR5 Results of surveys measuring customer satisfaction 33, 59 – yes, page 87


KPMG Financial Risk & Actuarial Services Ltda.Rua Arquiteto Olavo Redig de Campos, 105, 6th floor - Torre A04711-904 - São Paulo/SP - BrazilP.O. Box 79518 - CEP 04707-970 - São Paulo/SP - Brazil Phone No. 55 (11) 3940-1500, Fax 55 (11) 3940-1501 www.kpmg.com.br

Independent auditors’ limited assurance reportTo the Board of Directors, Executive Board and other Stakeholders of the Ladies’ Beneficent Society – Sírio-Libanês Hospital, São Paulo - SP

Introduction We were engaged by the Ladies’ Beneficent Society – Sírio-Libanês Hospital (“Sírio-Libanês Hospital” or “Company”) to apply limited assurance procedures to the information on sustainability contained in the 2015 Sustainability Report of the Sírio-Libanês Hospital, for the year ended December 31, 2015.

Responsibilities of the management of the Sírio-Libanês Hospital The management of the Sírio-Libanês Hospital is responsible for preparing and fairly presenting the sustainability information contained in the 2015 Sustainability Report according to the sustainability reporting guidelines of the Global Reporting Initiative - GRI (GRI-G4) and the internal controls it has determined as being necessary to permit the preparation of this information free from material misstatement, whether caused by fraud or by error.

Responsibility of the independent auditors Our responsibility is to express a conclusion on the information contained in the 2015 Sustainability Report, on the basis of the limited assurance engagement carried out in accordance with Technical Notice (CT) 07/2012, approved by the Federal Accounting Council, and prepared on the basis of NBC TO 3000 (Assurance Engagements other than Audits or Reviews), issued by the Federal Accounting Council (CFC), which is equivalent to international standard ISAE 3000, issued by the International Federation of Accountants, applicable to historical non-financial information. These standards require that we comply with ethical requirements, including independence requirements, and that the work is executed with the objective of obtaining limited assurance that the information disclosed in the 2015 Sustainability Report, taken as a whole, is free of material misstatement.

A limited assurance engagement conducted in accordance with NBC TO 3000 (ISAE 3000) consists mainly of questioning the management of the Sírio-Libanês Hospital and other members of the staff of the Company who are involved in preparing the information contained in the 2015 Sustainability Report, and in applying analytical procedures to obtain evidence allowing us to reach a limited assurance conclusion on the information on sustainability, taken as a whole. A limited assurance engagement also requires the execution of additional procedures, if the independent auditor becomes aware of matters that lead him to believe that the information disclosed in the


2015 Sustainability Report, taken as a whole, may represent material misstatement.

The selected procedures are based on our understanding of issues related to the compilation, materiality and presentation of the information contained in the 2015 Sustainability Report and of other circumstances of the engagement, and our consideration of areas and processes associated with the material information on sustainability disclosed in the 2015 Sustainability Report, where material misstatement might arise. The procedures consisted of:

(a) planning the work: consideration of the materiality of the issues for the activities of the Sírio-Libanês Hospital, the relevance of the information disclosed, the volume of quantitative and qualitative information and the operating and internal control systems which served as a basis for the preparation of the Sírio-Libanês Hospital 2015 Sustainability Report. This analysis determined the indicators to be tested in detail;

(b) understanding and analyzing the information disclosed in relation to the form of management of material aspects;

(c) analysis of the processes for the preparation of the 2015 Sustainability Report and of its structure and content, basis on the Content and Quality Principles of the Global Reporting Initiative - GRI (GRI-G4) Sustainability Reporting Guidelines;

(d) assessment of non-financial indicators sampled:

• understanding of calculation methods and of the procedures for compiling the indicators, through interviews with the managers responsible for preparing the information;

• application of analytical procedures to the quantitative information and asking questions about the qualitative information, and correlating it with the indicators disclosed in the 2015 Sustainability Report;

• analysis of evidence supporting the information disclosed;

• visits to the units and offices of the Sírio-Libanês Hospital to apply these procedures and those of items (b) and (c);

(e) analysis of the reasonability of the justification for omitting performance indicators for aspects and topics indicated as being material in the Company’s materiality analysis;


(f) comparison of indicators of a financial nature with the financial statements and/or accounting records.

We believe that the information, evidence and results obtained in our work are sufficient and appropriate as a basis for our limited conclusion.

Scope and limitations The procedures applied in a limited assurance engagement are substantially less in scope than those applied in a reasonable assurance engagement. Consequently we were unable to obtain assurance that we had been made aware of all the matters that would be identified in a reasonable assurance engagement, the purpose of which is to issue an opinion. If we had carried out a reasonable assurance engagement, we might have identified other issues and possible misstatements existing in the 2015 Sustainability Report.

Non-financial data are subject to more inherent limitations than financial data, given the nature and the diversity of the methods used to determine, calculate or estimate them. Qualitative interpretations of materiality, relevance and accuracy of the data are subject to individual assumptions and judgments. Furthermore, we did not examine the data given for previous years, in order to assess the adequacy of sustainable policies, practices or performance, nor the data given in projections for the future.

Conclusion On the basis of the procedures executed, which are described in this report, nothing came to our attention that might lead us to believe that the information contained in the Sírio-Libanês Hospital 2015 Sustainability Report was not compiled, in all material respects, in accordance with the Global Reporting Initiative - GRI (GRI-G4) Guidelines for Sustainability Reporting, and with the records and files which served as a basis for its preparation.


Shareholders’ Meeting 380 members

Advisory Council (2015-2018)

Executive CommitteeAnna Maria Tuma Zacharias PresidentDenise Alves da Silva JafetVice-PresidentLenah Barrionuevo Cochrane CutaitGeneral SecretaryAdriana Penteado Camasmie1st Secretary

MembersAdele Sader Abdalla Adele Zarzur Kherlakian Adriana Abdalla Hannud RizkallahAlzira Maria Assumpção Angela Haidar Chede Cecilia Elisabeth Cassab Cutait Cecilia Rizkallah Camasmie Claudia Camasmie Ferraretto Claudia Chohfi Cristiane Tamer LotaifCynthia Parodi Cutait

Dora Camasmie JeraissatiDulce Antonia Camasmie AbdallaEdith Jafet CestariEdmea Eduardo JafetEliane Cury NahasFernanda Jafet PontaltiFlavia Assad JafetGeorgia Abdalla HannudGisele Zarzur MalufGrace Tamer Lotaif CuryIrene Jafet PanelliLaura Emilia Calfat ChammasLeda Maluf HaidarLilian CuryLilian Dabus ZarzurLuciana Murad HannudMaria Angela AtallahMaria de Lourdes Flaifel Junqueira FrancoMaria Helena Andraus CintraMariana ZaherMarilena Camasmie RazukMarilena Racy BussabMarta Kehdi SchahinMary Calfat MaldaunMilena Abdalla HannudMilene Calfat MaldaunMonique Penteado Rodrigues HaidarNadia BondukiNeide SalemiRegina Atallah Sallum

Renata RizkallahRuth Salem SaderSandra Sarruf ChohfiShirley Chohfi Cury ZarzurSilvana Dacca CuriSilvana Said HaidarSilvia Yazbek CurySonia Abdalla JafetSylvia Suriani SabieVania Cutait de Castro CottiVera Assad Jafet KehdiVera Christina Saliba AbdallaVera Lucia ZaherVera Lygia Bussab SalibaVilma Calfat JafetVivian Anauate Elito Maluf

Fiscal Council (2015-2018)

Regular membersAntônio Sarkis Jr.Paulo André Jorge GermanosMarcelo Haddad Buazar

Alternate membersAlexandre Saddy ChadeMarcelo Chakmati

Organization structure


Ladies’ Executive Committee (2015-2018)

President Marta Kehdi Schahin

1st Vice-President Dulce Antonia Camasmie Abdalla

2nd Vice-President Vera Jafet Kehdi

General Secretary Georgia Abdalla Hannud

First Secretary Leda Yazbek Sabbagh

General Treasurer Maria Helena Andraus Cintra

1st Treasurer Claudia Chohfi

2nd Treasurer Renata Rizkallah

Equity Officer Cecília E. Cassab Cutait

HQ Officer Eliane Cury Nahas

Social and Events Officer Sandra Sarruf Chohfi

Social and Events Officer Marilena Camasmie Razuk

Public Relations and Disclosure Officer Sylvia Suriani Sabie

Social Action Director Edith Jafet Cestari

Social Action Director Maria Angela Atallah

Voluntary Work Officer Angela Haidar Chede

Honorary President Violeta Basílio Jafet

Board of Directors (2015-2018)

Angela Haidar ChedeClaudia ChohfiDulce A. Camasmie AbdallaGiovanni Guido CerriLuiz Henrique MaksoudMarta Kehdi Schahin (presidente)

Paulo Marcelo Gehm HoffRaul CalfatRoberto Kalil FilhoSérgio Carlos NahasTadeu Carneiro

Lifetime Council

Arlette Abussamra YazigiBeatriz Jafet ChohfiElizabeth Camasmie ZogbiEllye Zarzur CuryIeda Karan de Araújo ViannaIlda ZarzurIvette RizkallahLilian Nader AtallahLina Saigh MalufLourdes Henaisse AbdonLourdes Zarzur CuryLucia Camasmie KurbhiMagnólia Chohfi AtallahMaria Angela Kalil RizkallahMaria Sylvia Haidar SurianiMunira SalomãoMyrna Suriani HaidarNancy Luiza Pagnoncelli CuryRachel Tamer LotaifRose Zarzur CozmanVivian Abdalla HannudZilda Camasmie Taleb


Medical Committee Antranik ManissadjianAnuar Ibrahim MitreArnaldo José HernandezArtur KatzConrado Furtado de Albuquerque CavalcantiDaniel Deheinzelin (presidente)Gustavo Adolpho Junqueira AmaranteMarcel Cerqueira César MachadoMarcello Simaro BarducoRubens Vuono de Brito NetoSérgio Samir ArapYana Augusta Sarkis Novis

Committees and specialist groups

Clinical Management Advisory CommitteeHospital Infection Control Committee Certification Committee Nursing Ethics CommitteeMedical Ethics Committee Drug and Therapeutics CommitteeCritical Patient Committee Transfusion Standardization and First Aid CommitteeCPR Committee

Review of Death CommitteeMedical Records Review CommitteeCritical Unit CommitteeAdvanced Medicine Centers CommitteeIntra-hospital Transplant CommitteeVanguard CommitteeMultidisciplinary Nutritional Therapy Team

Acknowledgments

R$ 2.57 MILLION IN DONATIONSThe Ladies’ Beneficent Society – Sírio-Libanês Hospital has been supported by individuals and companies committed to its development and expansion since its foundation in 1921.

In 2015 fund-raising efforts produced a total of R$ 2,572,400.26. We thank all those who have contributed to the institution’s growth, and list below the individuals and companies that made a difference in 2015:

MAJOR BENEFACTORS

Carlos Alberto MansurFG – Farma Goiás Distribuidora de Medicamentos Ltda.Instituto João e Belinha OmettoVivian Abdalla Hannud

BENEFACTORS

Ahmad Ali BazaaniAssociação Comendador Assad Abdalla – Corgie Haddad AbdallaMafuci KadriSamir AbdenourVânia Maria Boghossian Marinho


Credits

Coordination

Sustainability Committee

Editorial and design coordination

Report SustentabilidadeAna Souza (projects and relationship manager),

Rúbia Piancastelli (editor), Guilherme Falcão (layout design), Gustavo Inafuku

(diagrams), Flavia Ocaranza (illustrations)

English versionJust Traduções

PhotographyJulio Vilela, Lilo Clareto and

Thinkstock Photos


2015 sustainability report - hospital sírio-libanês · 2016-10-10 · in 2015, we celebrated the...

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