HPA Magazine 13
If there was a company that literally did justice to the European year for Creativity and Innovation in 2009, it was the HPA Health Group, with the opening of a new hospital, which was also creative and innovative, the Hospital Particular de Gambelas, situated in the region’s capital.
This unit, with its modern and functional architecture, soon became a reference hospital in the Algarve, combining human and technological resources that have kept it up to date alongside the best in the country.
“A concept that combines unique health care in the region”, “an innovative hospital in its facilities, technology and services”, “the city of Faro is now richer as far as health is concerned”, these were some of the comments published by the press at the time of its opening. Today is celebrates its 10th anniversary, which brings us many good memories. A beautiful story of success and empathy, are the words of those who from the beginning, fell in love with the new project and gave themselves wholeheartedly to this new endeavor. A new project not only professionally but also a bold and challenging life project.
Hopsital Particular do Algarve - Gambelas
The ceremony of laying the first stone took place in February 2008 and the official inauguration held on the 9th of December, 18 months of some worries, headaches, but also many joys and laughter. It was a very exciting time for the organization, we could feel the involvement and participation of the various teams, the enthusiasm of belonging to a project from scratch, which we intended to be innovative and differentiating, recalls João Bacalhau, Chairman of the Board of Directors and the face of expansion and growth of the HPA Health Group.
The building was designed to provide comfort and functionality for its patients, but also innovation and differentiation for its professionals. When planning such a project, monitoring the construction of the building and selecting the equipment are key, but the core of the final outcome is the people, says Paulo Sousa Medical Director of the Gambelas Hospital, who has followed the whole recruitment process, especially that of the Medical Team. We started off with a group of approximately 350 professionals, including 125 doctors, with varied types of work contracts, and in less than five years we have almost doubled those numbers.
Going back to the physical aspects of the unit there are two main aspects that must be mentioned: Gambelas was one of the first ecological hospitals in the country and also, pioneer in having a computerized system where all clinical documents are patient-centered.
Ecological sustainability was fundamentally based on the state-of-the-art photovoltaic solar plant, says José Ribeiro, Engineer in charge of the Installation and Equipment Department. This equipment consists of 450 solar modules, which correspond to 900m2 of panels, with five inverters and one transformer station, producing about 170MWh / year of clean energy, which allowed us to avoid CO2 emissions, of about 52.7 tons / year, José Ribeiro proudly concludes.
The IT innovations implemented at the time outlined the future network of the HPA Health Group, which today includes more than 20 companies and thousands of computer terminals. Carlos Segundo, IT Engineer and Director of the IT Department points out: we have implemented for the first time in Portugal with PT, a Fiber Optic-supported VPLS for the implementation of the current MPLS VPN IP, a “cloud” that allows a network connection of the whole of the HPA Health Group. This has led to a crucial advantage and innovation for patients and professionals: the centralization of a single clinical process, he says enthusiastically. The new Gambelas Hospital permitted us to grow and innovate in other respects: it was during this period that we implemented the Intranet, the unique Data Center, the virtualization of servers with VMWare and the centralized PACS, which consequently allowed us to keep all exams and images of the whole HPA Group together.
It was predicted from the very first day that the Gambelas Hospital would be an example of quality and innovation, as it would be the first private hospital in the southern region of the country to have a Maternity, Intensive Care Unit, Hepatobiliopancreatic Center, Urology Center, among others, with all medical equipment chosen for its innovation and technological differentiation.
The loyalty and capacity of the clinical teams was crucial for the consolidation of Gambelas, one of the aspects we are most proud of, says Pedro Santinha, current Director of the unit. This conclusion can be observed from the growth that the unit has experienced. In the last five years for example, it has seen a 100% increases in most of the services provided and around 200% in others, as is the case with the number of deliveries.
Over the years the focus on differentiating services has continued, with the Oncology Day Care Hospital, the Neonatal Intensive Care Unit and the Cardiothoracic Surgery Unit.
As a result of emerging challenges and their inherent growth, in addition to the new services created, Gambelas has also seen the need for restructuring from a physical and organizational point of view. The confidence that the population has been demonstrating over the years has made us adjust to their constant needs, says João Bacalhau. We have for example, had to expand the Emergency Unit (Adults and Pediatrics) and the Out-Patient Pediatric Unit. In the near future, we will also have to alter the south wing on the 2nd floor of the building, to expand the Special Exams Unit and the existing In-Patients Unit.
The Orthopedics Team began its activity with the opening of the Hospital and, from the onset, with a very concrete objective: to create a structured team, with excellent academic medical experience, breaking away from the usual one-man private practice; with peer discussion involving each case, with a group spirit philosophy, says João Paulo Sousa, coordinator of the Orthopedics Department.
We have been faithful to this objective, and our goals have already been achieved, he said. Although we h ave already achieved a partial training status for medical specialists, our ultimate goal is to achieve total training status so that we can upgrade our services with intern training in orthopedics, thereby counteracting an established practice, that specialist training is unique to the public sector hospitals.
Our Orthopedics Department incorporates eight specialists, all trained in the Algarve, five full-time and three part-time. More than 10,000 surgeries and more than 8,000 out-patient consultations are an example. These include, besides the general orthopedics out-patients consultation, subspecialty consultations in shoulder, foot and ankle, knee and lower limb arthroplasty (hip and knee replacement).
The numbers should not be viewed in isolation, other medical indicators are equally important, patient satisfaction, and quality indicators, but the truth is that surgically they are a “valuable indicator of experience” and in our case the numbers are comparable to most medium-sized hospitals, namely the Faro and Portimão Hospitals, said João Paulo Sousa.
This department has published a significant number of scientific papers with more than thirty national communications, particularly at the National Orthopedics Congress, as well as a dozen international communications, mostly at the European Orthopedics Congress. As for publications, there are already three articles in international reference magazines, with two more in advanced production. The year 2019 was particularly fruitful, with nine approved papers at the 39th National Congress of Orthopedics, which took place in Tria, where we were the private service with the largest number of communications, seventh in general, only supplanted by large university hospitals.
The path we have taken has earned us national and international recognition, which has made us the international training center for the Smith & Nephew©, specific instrumentation for knee prosthesis system (where specific parts are specifically manufactured for each individual patient). We have been receiving interns and young orthopedic surgeons under a fellowship publicized and promoted by the Federation of Orthopedic and Trauma Trainees in Europe, whose first president is a member of our team. Most importantly, as mentioned above, we received accreditation from the College of Orthopedics of the National Medical Board for three-month internships in lower limb arthroplasty for inters in orthopedics, as part of their training for specialists.
This fact is important in itself, but above all, it is a first step for us to have an intern orthopedics training course as part of our unit, enabling us to give back to the Algarve this recently lost capacity that is so lacking, providing the population with these services and enabling professionals to settle in the region.
Summing up, we are aware that we are providing a service of excellence to the population of the Algarve, who are now able to avoid travelling to other regions.
It did not have the dimension, or the dynamics that we know today, although our first baby was born in the first days after its opening.
We began slowly, but quickly gained our place in Algarve’s birthrate, refers Patrícia Sancho, responsible for the nursing team of the Maternity Unit.
At the time, we did not have the medical or nursing staff we have today. We were naturally not able to maintain a 24hour emergency service, as we currently have today. Over the years, the teams have become not only larger, but above all permanent and specialized. With regard to, for example, nursing, we have a team of twenty-six specialist nurses in maternal and obstetric health including general nurses, who permanently work in the maternity ward, in the delivery room and in the postpartum ward.
The situation is the same as far as the Medical Team is concerned. There are eleven gynecologists/obstetricians, some still with additional subspecialties, in maternal-fetal medicine, senology and infertility, ensuring not only a Gynecological-Obstetric 24Hour Emergency Service, but also resulting in the units substantial growth, now known as the Women’s Health Department. This new Unit provides health care throughout the lifecycle of the women.
Both Teams are in fact very dynamic and dedicated; very much focused on the quality of care provided, mentions Ivone Lobo, Maternity Unit Director. Excellence in the care we provide our patients is a priority for us. Not only our medical results, but also those related to comfort, well-being, patient satisfaction. For us, every baby, every mom, every family is unique. The team is prepared to respond to all couples' expectations; we value each birth as a unique and memorable moment.
Training is another aspect highly valued by these professionals. In addition to weekly training sessions, periodically simulation courses on obstetric emergencies are held. I believe that we are one of the few hospitals to carry out these training courses, at least in the format in which we organize them; we simulate a real emergency, using actors, where all decisions are timed, with the object of reaching perfection, making sure that there is no margin for error. These courses are our guarantee that the existing “Via Verde da Gravidez e Pós-Parto” system do not fail while at the same time facilitating the requirements of our JCI International Accreditation.
// OUT-PATIENT CONSULTATIONS IN GYNACOLOGY
// ONCOLOGICAL GYNECOLOGY AND SYNOLOGY CONSULTATION
// CONSULTATION ON ONCOLOGICAL THERAPEUTIC DECISION
// OBSTETRICS CONSULTATIONS
// MATERNAL HEALTH NURSING CONSULTATION
These are the children that have sought medical assistance from this department: throughout the various stages of childhood, from premature to teenager. This Department of the Gambelas Hospital has been a presence in the lives of our children since the very beginning. Its growth has also been remarkable, if one considers its professional teams, its specialization, its training capacity, its physical space, in short: solidity and loyalty.
Focusing on children’s health has always been one of the administration's challenges and strategies, but it would not be an exaggeration to say that its professionals have superseded this challenge.
Although this department has always been on a separate wing of the hospital, its extensive growth has dictated profound alterations to its physical space. Today the children’s area has an exclusive wing with specialist consultations and a 24h Pediatric Emergency Unit, an In-Patient Unit and its most differentiated area a Neonatal Intensive Care Unit, the only one south of Lisbon, with technical and human resources, comparable to any of the best national or international units.
We can say that we feel very comfortable with our medical and nursing teams, not only due to their numbers, but especially due to their qualification and experience, mentions Luís Gonçalves, Unit Coordinator. We have a resident staff of nine specialists, four of whom are also Neonatologists and the situation is identical for the Nursing Team. This department has thirty-two nurses, about 1/3 Specialists in Child and Pediatric Health. In addition, we have the permanent support of fifteen Medical Auxiliaries and three Secretaries, in addition to other professionals such as Psychologists, Nutritionists and Physiotherapists.
However, feeling comfortable is not synonymous with having become accommodated, he stresses. We are constantly challenging our Teams, both in terms of quality care and knowhow. The result of this “restlessness” is evident by the clinical excellence result acquired through JCI, as well as the number of medical professionals that have attended our training courses. The numbers speak for themselves. In the past year we held sixty Training Courses, including the 3rdChildren's Congress, with approximately three hundred participants. In addition, our Team has been regularly present at national and international congresses, through the presentation of various publications. He continues saying: but more important still, is the satisfaction and daily recognition of parents and families of the children we treat; this is our commitment carried out with total dedication, making us stronger and more cohesive, increasing our desire to continue to grow and do better.
The department's major structural increases took place in 2014, with the extension of its services to a 24hour Pediatric Emergency and the opening of our Neonatal Intensive Care Unit, with Pediatricians and Pediatric nurses working on a permanent 24hour basis. During the past three years, additional alterations have take place with the extension of both the Out-Patients Consultations and Emergency Unit, resulting in an additional growth of 8%. The support of neonatal care is fundamental in monitoring our newborn infants, to guarantee the safety and tranquility that parents need during this very special period of their lives, dignifying a service that we know to be excellent, refers Patrícia Inocentes, Nurse in charge of the Department.
Dr. Luís Gonçalves adds that, the quality of care provided to a newborn infant, especially if it is premature is an indisputable quality parameter; we can therefore say that our experience has been totally rewarding.
I believe that some very important aspects must be highlighted especially when it comes to prematurity: we only obtain positive results if we work with feeling, passion and dedication. This is our formula and our motto to “raise” healthy and happy children, concludes Patrícia Inocentes.
// PEDIATRIC SUBSPECIALTIES AND SPECIALIZED CONSULTATIONS
years after Dr. António Fráguas joined the HPA Health Group. Oncologist, Dr António Fráguas, is well known and respected throughout the Algarve. He has since 1982 been working to ensure that cancer treatment and its aftercare is decentralized from the large urban centers. The main object being to improve and extend its accessibility and above all, for it to become more convenient, resulting in an added quality of life for cancer patients.
Founding member of the Portuguese Society of Senology, Dr Fráguas is therefore a great promoter of early diagnosis and treatment of breast cancer. His first Oncology Unit away from a larger center was first established in 1983 at the Public Hospital in Évora. Once retired from public service, the option of doing the same for the Algarve came about naturally, this time in a Private Hospital.
In the past few years with the constant arrival of new therapies, such as immunotherapy and target therapies, fighting cancer has become revolutionary. The good results obtained in the treatment or cure of this disease have indicated that we are on the right path, refers Dr. André Oliveira, current coordinator of the Oncology Unit.
Current improvement in diagnostic techniques must also be highlighted. Genetic study, once difficult to access and time-consuming, has now become possible for any patient. Presently, access to studies of circulating tumor cells and using liquid biopsies to search for oncogenic mutations has become a reality for certain types of pathologies such as colon, lung or melanoma.
A decisive aspect in these advances has been research, which has become easier with the addition of another Specialist joining the team, Dr. André Andraz Cruz.
Oncology is one of the most proactive medical specialties, and it is imperative that professionals combine practice with investigation. In our unit, we have progressively managed to create this system, with some clinical trials already underway (see page 76).
The Day Care Hospital with its private regime has some advantages such as, for example, easy and almost immediate access to cytostatic chemotherapy with its different protocols, both oral and intravenous; the waiting time to start treatments is minimal, says Raquel Salgado, the nurse responsible for this Department. Another advantage is the possibility of carrying out treatments covered by the various health system, such as ADSE, ADM, national and foreign Health Insurance Companies.
After eight years it is legitimate to state that the Gambelas Oncology Day Care Hospital is a solid unit, with access to the latest techniques and treatments available in the area, where multidisciplinary teams regularly meet and discuss not only the best treatment options, but also the best conditions for the patient and family, as far as well-being and quality of life is concerned.
Paulo Sousa, Director of the Surgical Department and also Medical Director of the Hospital, is passionate when discussing this topic: we have well-trained surgical teams, capable of carrying out interventions with an exceptionally high level of differentiation. An example of the various procedures where the skills of our teams are considerable and on the same level as major surgical centers are: hepatobiliopancreatic surgery, colorectal surgery, cardiothoracic surgery, neurosurgery and made to measure knee prostheses.
Alongside the technical knowhow of the surgical teams, it has been equally important to highlight Management investment in equipment of advanced technology, where the option always has a common denominator, which is called safety and the possibility of carrying out minimally invasive surgery.
In fact, laparoscopic minimally invasive surgery (keyhole) has numerous advantages, as it results in less pain for the patient, less blood loss, shorter hospital stay and consequently a faster return to work and social life. Aesthetic results are also much improved. After a period of time scars become practically imperceptible due to their reduced number and size.
Laparoscopic surgery has already become a routine practice in Gambelas and almost all patients can be operated using this technique, says Paulo Sousa, however it may not be possible for patients with severe respiratory problems or with multiple previous interventions on the same location. Continues Paulo Sousa, even in very complicated situations, such as morbid obesity or cancer, laparoscopic surgery manages to achieve a success rate higher than the conventional approach and is preferred by both patients and surgeons.
All surgical specialties have seen a substantial increase, both in the number of cases and in their differentiation, one of which is cardiothoracic surgery. Indeed, the complexity of these interventions has been increasing not only in the number of programmed surgeries, but also in emergency surgeries. Thoracic Surgery in for example, lung cancer surgery has become more and more common by single-port video thoracoscopy, which is considered an extremely differentiated technique.
Finally, Dr. Paulo Sousa also stresses: it is important to emphasize that the excellent results we have obtained in the surgical areas are dependent on our teams of multidisciplinary staff, including anesthesiology, nursing, operating theater and in-patient units. I also want to highlight the fantastic support of our intensive care unit, which allows us to rely on all the necessary safety measures possible in these areas. We have in fact a set of human resources and technical means in perfect harmony permitting us to perform about 8,000 surgeries per year.
Nurse Luciana Matos has been working at the Gambelas Hospital from the very 1st day and has been its nursing coordination for the past 4 years, so she knows its structure and evolution very well. As a nurse, these past 10 years of care and growth have only been possible with commitment, passion and perseverance. The last few years have seen exponential growth, where we were forced to learn a lot, mature quickly, both as professionals and as people.
Although very young, we have found our teams to be dedicated and committed professionals, considering the countless messages and letters received from our patients. Postgraduate training has provided them with additional skills and knowhow and is another very important factor for the professional growth of our nursing staff. The number of specialist nurses with master's degrees is already very impressive. Training courses are available at the Gambelas Hospital almost every week dealing with the most varied nursing themes.
It is important that we instill in our younger nurses the HPA culture, says Luciana Matos, a culture where the relationship with the patient goes beyond providing nursing care, it is a relationship of closeness and affection; it is knowing how to make patients feel welcome, it is knowing how to anticipate patient’s needs.
Basically, it is knowing how to make the patient feel that he is effectively the center of our care, the center of our attention, that he is in unique and special.
This could be the motto that defines the Quality and Environment Certifications obtained, as well as the Joint Commission clinical evaluation and accreditation.
ISO 9001 Certification attests that procedures and responsibilities are aligned with the organizations established policies. Its objectives are based on quality criteria and its final results are focused on patient satisfaction.
This Quality Certification of the Gambelas Hospital was obtained in record time; less than 6 months by SGS. It is true, that this goal was achieved in record time, comments Dr. Ana Coelho, who was at the time the person responsible for this process. We had a gained advantage; the know-how acquired from the certification of the Alvor Hospital (certified since 2007). Although the Gambelas Hospital has additional services, the procedure was very much facilitated.
Obtaining Environmental Certification came next, July 2012. This time simultaneously, in both hospital of the Group. Continues Ana Coelho, considering the complexity of the environmental requirements related to waste management in hospitals, the experience and know-how we had acquired in the processes of the Quality Management Certification, obtaining Environmental Certification seemed quite easy. However, we must mention that these norms were updated in 2015, resulting in added environmental demands in this area.
At the same time in 2013 the Gambelas Hospital voluntarily requested an audit by the Entidade Reguladora da Saúde, the national system known as Sistema Nacional de Avaliação da Saúde (SINAS), and the results have been excellent in all in the areas evaluated: Clinical Excellence, Patient Safety, Suitability of the Facilities and Patient Comfort, Patient Focused and Patient Satisfaction. This annual audit has been ongoing since 2013.
In 2018, it was decided that the time had come for both the Gambelas and Alvor hospitals to be accredited by Joint Commission International. Experts from the most important international institution dealing with Clinical Accreditation reviewed our compliance with more than 300 standards of excellence and more than 1000 parameters related to patient safety and quality care.
Luís Fernandes, Qualified Nurse and Manager of the Quality Control Department, responsible for this process, is convinced that: becoming a part of the group of hospitals considered to be the safest in the world, located in the most touristic region of Portugal, is a good reason for everyone to be extremely proud, not only on a regional level, but also on a national level. Continuing, he also mentions: JCI Accreditation put our hospitals to the test as far as their maturity regarding safety and quality of clinical practices and also non-clinical services, in key areas such as patient assistance, infection control, and medical and surgical care. We were able to respond to this challenge, with the commitment and motivation of all the teams involved, but also with the organizations leadership.
We are sure that the growth we have experienced during these past years will have the same evolution and progress in the future. The alterations that are presently underway will considerably benefit the hospital facilities, both in the Out-Patient and In-Patient Departments.
The Out-Patient’s Consultation Unit on the Ground Floor will undergo changes in as far as the allocation of additional space for various specialties, but the more significant alterations will be taking place on the 2nd Floor with the addition of an extra In-Patient’s wing.
This decision was reached not only due to the substantial growth experienced in some areas, but it was also due to the acquisition of new equipment, which due to its nature required specifically adapted space.
To cope with these alterations, most of the administrative and financial services have been housed in continuous buildings, outside the main building of the hospital. This was the most functional way that we could find to gain space for the much-needed medical areas. With this remodeling it will be possible to improve the functionality of some specialties such as special exams; gastroenterology and urology, including more versatile consultation rooms and a new wing for the Women Health Department. The Oncology Day Care Hospital will also be moved to another part of the hospital. Finally, an additional MRI Machine will be added to the Imageology Department in an area previously occupied by admin staff.
These alterations will bring substantial advantages to the functioning of the hospital, especially as far as the comfort of our patients is concerned. The additional space gained for medical practice will provide the professional staff with a more functional hospital and in some specialties increase their working capacity by 30% or more.