Benchmarking in healthcare: learn from the best

Some of the most reputable hospitals in the world usually open their doors to visits by specific doctors and managers in benchmarking. Here are 17 institutions that can help improve your organization’s performance.

In an increasingly globalized world, benchmarking is a more common alternative to align operations around the world with the most modern management and assistance available, whether in an industry, at the ice cream shop on the corner or in the immense healthcare market on the five continents. . But how can we gather, in a didactic and summarized way, experience opportunities in the main health services around the world? I took on this challenge. I contacted more than 150 institutions from different countries, of which 17 were willing to open their practices in the medical, administrative and support areas — some even have specific programs for this. Among them, there are those who receive visitors throughout the year and those who only have a predetermined window or those that must be scheduled for this.

In most cases, however, it is not easy to practice competitive benchmarking, that is, comparing yourself to companies that operate in the same sector. From Singapore, a large hospital in the capital was emphatic: “We cannot discuss our commercial and operational practices”.

Financial data, for example, is generally considered state secrets. “I have already participated in a series of initiatives to exchange information between hospitals, all of which were frustrated, because one did not trust the other”, admits Carlos Buchpiguel, medical superintendent at HCor, in São Paulo. “Everyone makes a point of talking loud and clear about how they treat a disease, how they structure their units, but when it comes to price, coverage and care requirements, one is deceiving the other.”

But there are always proposals, such as HCor itself, which agreed to collaborate with the survey and, in addition, hospitals in the United States, Europe and Latin America — including Brazilians such as Hospital Israelita Albert Einstein and Hospital Sírio-Libanês.

South Florida Baptist Health

In the US state of Florida, we found an institution recognized for its standards of ethics, sustainability, innovation and patient satisfaction — and for being a good place to work. Baptist Health has eight units, which receive more than one million people per year, of which 12 thousand come from Latin America and the Caribbean. The hospital welcomes students, doctors and administrators from around the world to share knowledge and practices. In the Shadowing & Observational Rotation program, it opens up the opportunity for international visitors to get a perspective on how the United States medical system works, according to Baptist Health periods. “The observers participate, with their North American colleagues, in the day-to-day life of an international cooperation medical center through interdisciplinary cooperation between education, diagnosis and treatment”, describes Sahyli Hartney, from the institution’s marketing and international communications department.

The international program was created just over three years ago. Anyone who wants to participate must comply with the regulation criteria: be at least 16 years old, be supported by a licensed doctor with clinical instructions at the facility where the program takes place and stay there for an observation period of a maximum of six weeks . Doctors also need to present letters of recommendation attesting to a good consultation — professionals from another area must hire a background check carried out by an entity indicated by Baptist Health. Most visitors seek surgical specialties, but the program includes modules such as medical rounds, operating room procedures and healthcare management best practices.

What it offers : The hospital has an observation program for doctors and non-physicians lasting up to six weeks, available year-round. Observers must pay accommodation and food expenses.

Carolinas Health System

It is a network of 40 hospitals in the states of North Carolina and South Carolina — which, together, have an estimated population of 15 million inhabitants. With an annual budget of US$8 billion, it is respected for being innovative in patient care, in the oncology and pediatric areas. These distinctions resulted from the creation of the International Medical Outreach Program (Imop), carried out in partnership with the Heineman Foundation, based in the city of Charlotte (North Carolina).

Imop was designed by the Heineman Foundation in the 1960s, and is currently seeing an increase in visitors. To apply for the program, you must send an email. Afterwards, professionals are evaluated to see if they meet the requirements for the intended visit and to define its duration, which can be from two to 12 weeks. According to Deborah Neffa Creech, from the communications department, there is no predefined limit on the time that can be spent at the facility, as the program’s mission is to improve healthcare in countries with limited resources.

In the case of professionals working in precarious facilities, low-income transfers, the program guarantees financial support. What is common to all is the offer of a guest house, a building to accommodate visitors on a first-come, first-served basis and, when necessary, the organization helps to find other accommodation.

The public most interested in Imop is clinical staff, whose main interest lies in the area of cardiac care (diagnosis and treatment of heart diseases, cardiology and cardiac surgery), orthopedics and emergency care (traumatology). Visitors come from different countries, especially from South and Central America (Guatemala, Belize, Chile) and Dar es Salaam, Tanzania. Deborah directly highlights the role of the institution and the development program of the Guatemalan Heart Institute (Unicar), which successfully responded to the knowledge acquired during visits to the United States.

What it offers: A free two- to 12-week program in which international visitors learn from clinical experts using state-of-the-art equipment. The hospital offers accommodation.

Henry Ford West Bloomfield Hospital

It is one of the North American institutions most sought after by doctors, executives, university students and, interestingly, by professionals in the food sector — not only to take a closer look at what is being done, but also to ask for information. Such interest encouraged the hospital to create a program to share best practices, says Sally Ann Brown, public relations specialist at Henry Ford. She comments that the hospital was the target of professional curiosity even before its opening in 2009. At the time, “helmet tour” programs and guided visits to prototype rooms were created, which allowed a closer look at the works of Construction of the building is about what was being born on site.

Currently, the institution offers a one-day program. Its greenhouse and its commitment to raising awareness among people to adopt a healthier diet explain why the food sector is one of the main details on visits to the facilities — the Henry Ford Health System employs more than 23 thousand people and serves 3.2 million patients per annum. Those who also have a regular presence are professionals and retail executives for healthcare establishments, quality and service excellence.

What it offers: doctors and professionals can make one-day visits with a scheduled date — in 2015, availability was 4/24 and 10/15. The cost is US$750 per person and includes food, but not accommodation.

El Cruce Hospital – Néstor Carlos Kirchner

Despite being the main starting point for professionals looking for reference practices, Latin America is also an important destination. El Cruce is considered the second best hospital in Argentina and one of the best in Latin America (fourth, according to a poll carried out in 2014). Its 2013–2017 Strategic Plan includes an alliance with the Arturo Jauretche University for teaching and training health professionals and aims for it to become an international reference center. Since 2009, national and international visits have been arriving in search of more knowledge.

Professionals generally make one-day visits, and the hospital’s preferred period is from March to November, according to Ricardo Otero, head of the quality area. Favorite practices for benchmarking are quite diverse, ranging from clinical and patient management to hospital architecture. Quality, pharmacy, nursing, simulation-based learning and diagnostic imaging and laboratory are other areas that complete the list.

Although the majority of visitors come from other cities in Argentina, Chile, Bolivia, Paraguay, Colombia and the United States are also represented in Buenos Aires. The spirit of openness is total and, according to Otero, “there are no limits to the possibilities. It just depends on the needs of our visitors.”

What it offers: visits that generally last one day, but can be continuous for up to two weeks — in the first case, it is free; in the second, there is a calculation according to the duration and complexity of the practices observed.

Medellín General Hospital

The Colombians carried out a benchmarking process that welcomed both local and international audiences. Since 2006, the hospital, based in the capital, Medellín, has received 50 visits per year — totaling an average of 250 professionals, from January to December. Gustavo Giraldo, head of planning quality at the entity, makes it very clear that visits must be carried out by professionals, but on behalf of an institution.

To do this, you need to fill out a form. The next step is to coordinate between the interested party and the person or process chosen as the target of study. The sharing of practices and knowledge at the Hospital General de Medellín encompasses topics such as quality management, patient safety and administration of the pharmacy system, says Giraldo.

What it offers: free visit and carried out within a period of two to eight hours; Meals and accommodation are paid for by the visitor.

São Vicente Foundation

Still in Medellín, we find this university hospital whose vocation is to share knowledge to train better professionals since its foundation in 1913. Each month, the institution receives 500 students in the health field, 280 of which are residents of clinical specialties and surgical.

The hospital center shares itself with medical professionals from all over the world as reference practices in its strongest areas: highly complex patients, case volume, interdisciplinary care, cutting-edge technology and a care model based on the humanization of care, safety of patient and early rehabilitation. We also hold 600 academic meetings per month to discuss cases and medical updates on clinical and surgical management.

To apply for training, you must fill out a form and wait for a response regarding the availability of the desired service. The selection takes place throughout the year, and healthcare professionals come from countries such as Spain, Scotland, Germany, Japan, Brazil and Argentina. The areas served are: trauma surgery, burn patients, neonatology, plastic surgery, internal medicine, pediatrics, rheumatology, endocrinology, emergency medicine, transplants, oncology care, infection prevention, patient safety and discharge patient care complexity.

What it offers: the duration of the visit can vary between two weeks and three months, depending on the time considered necessary to have a better experience; one institution charges $300 to $900 (room and board not included).

Cardioinfantil Foundation

Still in Colombian territory, we spoke with Juan Camilo Bustamante, head of clinical operations at Fundação Cardioinfantil, based in Bogotá. He explained succinctly that the hospital has an office responsible for managing visit requests — some short, others longer. The Institute of Cardiology is in the process of becoming a university hospital, and one of its objectives is to contribute to the dissemination of medical information. Bustamante firmly states that the institution “wants to share this knowledge”.

As it is a cardiology center, it would be easy to assume that this would be the area preferred by foreign doctors, but the institute also offers training in other areas, and mainly welcomes neighbors from Central America, especially Panama, the Dominican Republic or Ecuador. Visitors may circulate within the facilities only as observers.

Akershus University Hospital (Ahus)

Opened in 2008 in the city of Lørenskog, Norway, it is considered one of the most modern hospitals in Europe. The institution has a variety of programs for visitors — from short visits lasting about an hour to more open-ended excursions that last a day or more. Visitors come mainly from other hospitals, but some are from higher education institutions or public and private healthcare organizations.

Currently, Akershus receives, on average, 75 visits per year and the peak number of visitors was reached in the first few years after opening, mainly in 2011 and 2012.

During the visits, the selected topics vary: from innovative logistics and automation at Ahus to the project planning process, the use of information technology and the architecture and decoration of the building. “We have open arms for doctors and health professionals. In a university hospital, it is normal to have this training, as well as meetings and seminars on the subjects we are good at”, says Marie Sleveland, visiting coordinator at the hospital. She has worked in the Norwegian hospital sector since 1973 and says that this is a practice she has been accustomed to since the beginning of her career. As for foreign professionals, they are only received when the hospital wants them to visit and leave their opinions and opinions.

Still at the beginning of the operation, in 2009, Ahus visited Brazil. As the building is a world reference in terms of architecture, it welcomed an architect from Minas Gerais. To do the same, other Brazilians can simply send an email. To schedule a visit, simply present and inform what you want to see, what your object of interest is, how many people are in the group and which days and times are most convenient, explains Marie. With this information, Marie herself prepares the entire visit program, including the guided tour and any presentations.

The hospital also makes contacts with other university institutions to make presentations. It frequently invites universities to courses and seminars on primary care. This type of program requires payment — for meals or teaching materials — and is not restricted to academic or Norwegian audiences.

What it offers: the visit, in general, takes between an hour and a half and two hours, but can last up to two days; the hospital does not guarantee accommodation, but offers lunch.

Uppsala University Hospital

Anyone who wants to venture into the Nordic countries can take advantage of the same trip to visit this Swedish university hospital, which is less than 500 km from Ahus, across the border, in the city of Uppsala, located 72 km from the capital, Stockholm. The team at this hospital also receives specific information about its best practices. Every year, Uppsala receives several visitors, but in different ways.

There are organized groups made up of executives who intend to learn lessons from their management model and doctors, who give an individual tour. According to the Uppsala communications department, the majority of them choose that hospital to practice medicine.

What it offers: the hospital receives, separately, groups of doctors and executives from the area to talk about the business model and take a tour of its facilities.

Barcelona Center Médic (BCM)

In the Spanish region of Catalonia, an institution usually receives doctors from different specialties, not just managers and administrators — always respecting criteria for serious benchmarking and presenting qualified certification. The director of BCM, Maria José Miravitlles, says that she is very pleased to welcome all professional classes who wanted to know more about what the hospital does, including journalists. Recently, the medical center hosted a delegation of 25 Russian medical executives.

Hospital Israelita Albert Einstein

In Brazil, we spoke with HIAE, which received the distinction of best hospital in Latin America in recent years — which makes it an interesting target for benchmarking. Despite not having a technical visit or formal benchmarking program, Felipe Spinelli, director of teaching at the Instituto Israelita de Ensino e Pesquisa, mentions the Einstein Excellence Management Program, aimed at leaders (directors and presidents) of hospitals, health institutions and other areas. “It is the evolution of some visits made. The difference is that it is formal and deeper in each area of the institution”, he states. In 2014, the program was built by Einstein based on the purpose of disseminating knowledge and best practices. “This exchange makes us learn a lot with the opportunity to have other views and questions”, says Spinelli. The initiative provides for the sharing of information on topics in which HIAE is a reference and provides an overview of the institution and the Brazilian health market, in addition to dealing with topics from different areas (hospital, diagnostic medicine, teaching and research) and related to clinical staff management. The guided tours show points such as the Realistic Simulation Center and the Oncology Center to groups of directors of health institutions and even classes of MBAs, directors, presidents and leaders of companies from other sectors.

The program is held once a year and lasts two days; Its cost is R$6,500, which includes presentations, visits and lunch.

São José Memorial Hospital (HMSJ)

The Pernambuco institution was the first in the North and Northeast to receive accreditation from Joint Commission International, in January 2012, the date that marks the beginning of knowledge exchange. Before that, however, the hospital already had a Clinical/Non-Clinical Risk Management Program, started in 2008.

According to the HMSJ press office, these practices are being gradually adopted by most Brazilian hospital institutions, which have been visiting the facilities for years, but also attract the attention of all foreign observers. In 2012 and 2013, teams from Turkey and the United States were in Recife to visit Memorial São José — the first hospital with Joint Comssion certification in the Northeast. The objective was to see up close how the institution managed to have VTE (venous thromboembolism) indicators below the infection control standards defined by the World Health Organization.

In addition to visits, HMSJ has been publishing articles and research about its experiences in national scientific publications, and the risk management and infection control team has been in great demand to give lectures and short courses throughout Brazil and European events.

Saint Camillus Hospital

Technical visits to this network of hospitals in São Paulo attract trained professionals who are interested in learning about some management activity related to their area of expertise. Daniela Tamássia, HR manager at the São Camilo Hospital Network, defines external benchmarking as “a moment rich in opportunities to exchange best practices”. For around five years, the institution has had a program to integrate professionals from different segments.

Those interested in participating can request participation through the network’s website — it is necessary to indicate the data of interest and which areas of interest to visit, such as the Quality Center or the Realistic Simulation and Supplies Center, which are among the most requested. During this visit, comparative data and international trends are shared. “The visitor will have access to promotional materials, and additional materials will be submitted for authorization by the directory of the area visited”, explains the advisory.

The hospital offers a one-hour tour for visitors to learn about areas such as quality, finance, service, hospitality and the Realistic Simulation and Supplies Center.

Saint Joseph Hospital

In São Paulo, Hospital São José, run by Beneficência Portuguesa, offers two exchange programs in oncology, in force since 2011. They are two programs with different orientations and recipients, but restricted to Brazilian professionals. The Observer Program is aimed at post-residency doctors and is carried out over a period of one to two months, without institutional subsidies. Among the associated centers, the HSJ advisory highlights Inca and the Barretos Cancer Hospital. The Fellowship Program welcomes doctors post-residency in oncology, lasts one year and provides for the professional’s remuneration. There are two programs for doctors — one lasting up to two months and the other lasting one year.

National Institute of Traumatology and Oncology (INTO)

Another institution based in São Paulo, INTO, has 45 residents in training, a professional master’s degree, a lato sensu postgraduate degree and offers a specialty in knee, hip and spine surgery within orthopedics.

Visits can be scheduled on the hospital website, and participants have the option of a medical residency, master’s degree or postgraduate degree in the subspecialty. Into also welcomes observers. “Foreign professionals cannot enter surgery and a colleague from another state cannot operate, as they do not have a CRM, but they can see the facilities, surgeries and exams”, points out João Matheus Guimarães, director of Into. One of the last observers, he says, was a professional from Argentina who spent 15 days selling highly complex surgeries.

The institute also has a residency in nursing and nutrition and organizes seminars, including on topics such as public administration. “We are a reference on this subject”, says Guimarães. To share good practices, there are partnerships such as those with the International Society of Orthopedic Centers — according to Guimarães, Into is the only Brazilian to be part of the group, which has a partnership with the most famous orthopedic hospital in the United States, Special Surgery — and agreements with national hospitals and research laboratories.

The details range from a week to 15 days visiting the hospital to see what is most modern; Into offers accommodation for residents, but visitors pay for their accommodation.

Sírio-Libanês Hospital

For this philanthropic hospital in São Paulo, sharing knowledge is a social responsibility. “What we researched and learned, we have to pass on”, says Antonio Eduardo Antonietto, relationship manager with the clinical staff at Sírio-Libanês. The entity has a Teaching and Research Institute (IEP) and, in partnership with the Ministry of Health, provides training for the entire Unified Health System. Antonietto puts numbers on the table: “In 2014, we trained 20 thousand SUS professionals, nurses , physicians, and all other levels of hospital work, all within hospital ranges.”

For him, it is important to share data with the public and with the competition. “People today are more informed, and the internet allows for the publication of countless information, so there are conditions to understand these indicators and classify the hospital. Benchmarking was just the beginning of making information available so that consultation and comparison can be carried out”, he says.

Every year, professionals from Brazil and other countries attend Sírio-Libanês. The most sought after areas are relationships with clinical staff, oncology and research, linked to the IEP. Although the hospital does not have a program, there is a willingness to receive anyone who requests a visit.

On a recent mission, a team from Hospital Alemão do Chile came to find out how Sírio-Libanês carries out medical and clinical staff assessments. France, Iraq, the United States, Argentina and Angola — which hosted two missions in 2014 — are other examples of countries that have already taken advantage of the Sírio-Libanês hospitality. After scheduling a visit, the hospital will determine whether any amount will be charged.

The hospital does not have a program, but it receives Brazilian and foreign visitors, and highlights the appropriate professionals to talk about the chosen topic; The initiative is free, but in some cases there is a charge for the visit.

HCor (Heart Hospital)

The round of Brazilian reference hospitals could not fail to include Hcor, in São Paulo. Its visitors see an overview of what is done at the hospital and discover that it is open to external benchmarking, mainly among institutions considered to be of excellence by the Ministry of Health. “The hospital has been structuring itself to more broadly meet the obligations of executives and from the boards of other institutions”, says Carlos Buchpiguel, medical superintendent.

According to him, there are no restrictions on visiting any area. “We are structuring the development of extension and lato sensu postgraduate courses to enable training in the area of care and hospital management”, says Buchpiguel.

To visit Hospital do Coração, in the capital of São Paulo, simply place an order and get in touch with a professional or team of interest. The unit is open for benchmarking.

(See Part II – Cleveland Clinic Case)

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