Brazil has now become one of the epicentres of the COVID-19 pandemic, and the burden on its healthcare system is increasing daily. Paulo Moll, CEO of Rede D'Or São Luiz (RDSL), the largest privately held, independent hospital operator in the country, speaks about the measures taken on the national level and within the RDSL system and shares his views on the future outcomes of the pandemic for his company and his country.


The Public Health Emergency of International Concern was declared in Brazil in early February. What was RDSL’s reaction to this?

Here at RDSL we created a COVID-19 response committee in January. Since then, we have been working on two effort areas: one being administrative and epidemiological and the other care delivery.

Within the first effort area, we have created a mathematical model to predict the development of the disease, in addition to reorganising administrative operations so that they could be done remotely. We have also reorganised purchases of supplies, such as personal protection equipment, and materials, medicines and intensive care equipment. Having done that we could safely serve our patients and, at the same time, protect our employees.

In the care delivery area, we have established guidelines for the patient care of these patients, and separated the flows, equipment and areas of care so that COVID-19 patients and others could be treated safely and quickly. We have also started monitoring patients with confirmed COVID-19 infection, even those not hospitalised, as we have activated a telemedicine service with monitoring and guidance capabilities. In addition, we promoted intensive training of our employees so that they could safely care for patients and protect themselves properly.

RDSL has dozens of facilities across the country – how are they being utilised for the COVID-19 patient care? 

All of our units have a predetermined service guideline, as well as exclusive flows for patients with suspected COVID-19 infection. We have expanded our emergency departments and defined the internal flow of COVID-19 patients so that they do not intersect with the flow of other patients. We have also dedicated part of the diagnostic equipment to these patients and created specialised units and areas for them.

This was essential for us to be able to serve more than 30 thousand patients with confirmed COVID-19 infection that referred to our hospitals.

Your operational model is highly centralised. Considering the varying conditions across the regions RDSL is present in, how do you adjust to the changed circumstances?

We have centralised back office services such as IT, purchasing and a call centre. There are also general guidelines with regard to diagnosing and treating COVID-19 patients to be used in all our hospitals. However, the operating activities of our hospitals also have a high level of independence, which gives us efficiency and speed without the need for specific adjustments at a time like now.

RDSL is proud of its ‘Smart Track’ system of examining patients admitted for emergency care. Have you been able to use it with COVID-19 patients?

The flows of patients with suspected COVID-19 infection are exclusive and independent from the flows of other patients. With this separation of flow and the expansion of the emergency departments, not all of them remained with the architectural structure that supports our ‘Smart Track’ system. However, it is based on speeding care and security with double-checking of patients by two different doctors, and this has been maintained for all patients. Remarkably, RDSL patient satisfaction increased to over 70 in Net Promoter Score (NPS) all over the company, and above 95 in our Star units – slightly higher than our historical scores.

RDSL also has a sophisticated business intelligence (BI) ‘Mobile Analytics’ platform –is it delivering the desired results in such volatile period?

Our BI system is very well implemented and captures information directly from electronic medical records and hospital information systems. No doubt it remains extremely important at present time.

A major part of your business is insurance. With fee-for-service and bundled payment models available in the network, which one is more efficient with COVID-19 care, and why?

Both models can be used efficiently, depending on the understanding between the parts. Today, a relevant part of RDSL's billing is already by bundled payment and in these cases we are negotiating an extra fee with health plans to cover the additional costs that this disease brings.

A decision to integrate health information nationally has been announced recently by the authorities. What will be the impact of this for private health systems such as RDSL? 

The government has been trying to integrate health information on the population level for many years, but to date such projects have not been implemented. In RDSL, the information regarding patient care has been integrated for several years now.

There have been episodes of general public assaulting healthcare workers in Brazil. What would be your message to both sides? 

It was a regrettable isolated episode that does not reflect the feeling of the Brazilian population. Our people are kind, respectful and hardworking, and healthcare professionals enjoy an enormous social reputation.

There are many pessimistic projections of Brazil’s healthcare system collapsing under the COVID-19 burden. What are your expectations here? 

Brazil is a continental country, and the healthcare system varies among different states and will perform in a different way during the pandemic. Having said that, we are sure that healthcare providers and patients in need will continue to exist in the post-COVID-19 era.

How is the projected economic decline in Brazil going to affect its healthcare sector?

It depends on what happens to the country's economy and jobs, but again I say that the healthcare sector in every country in the world has patients and healthcare providers. Here it will also continue to be so, and we will do our best for our company and our country. Our society will always be able to count on us, and we will remain firm in our mission of providing high-quality healthcare to our population.

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