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Medical Assistance Medical Department

To talk about growth, quality indicators, continuos improvement, innovation and contribution to higher education, are challenges that we face daily. This task is difficult given the current situation of the Colombian Health Care System. In 2013, the number of patients cared for in our 471 bed hospital increased by 4% in relation to 2012. In 2013, a total of 351,189 were seen in outpatients, 66,044 in emergency services, 20,251 were admitted to hospital, and 14,707 underwent surgical procedures. However, more than the number of patients treated or the surgeries performed, for us is important to maintain our standards of quality in such a way that they are not affected by growth.

to evaluate quality standards. The America Economia Magazine rated us first among Colombian and fourth among Latin American Hospitals.

Our 5,1% overall mortality rate is comparable to that of third level hospitals in developed countries such as the US. The rate of hospital acquired infections, a safety indicator, is 4,45 x 1000 patientdays; the international parameter reported for academic multispeciality hospitals is 11 to 16 x 1000 patient-days.

Nine specialists and subspecialists have joined our medical staff; they are:

In 2013 we continued to be accredited as an institution of Excellence by ICONTEC, the official agency appointed by the Colombian Government

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In 2013, 60 original articles written by our proffesionals,were published by national and international scientific journals. Six research projects were awarded prizes at national and international scientific meetings. This is our contibution to knowledge, one of our pillars. None of our achievements would have been possible without the committment of our doctors as cornerstone of our health services.

Dr. Juliana Escobar (Pathology), Juan Gabriel De Los Rios (Urology), Luis Alberto Escobar (Pathology), Bladimir Pérez (Pathology), Jhon Faustino Bastidas (Oncology Surgery), Manuela Olaya (Pediatrics and Allergology subspecialist), Dr. Juan Camilo Castro (Radiology), and Fabio Bonilla (Internal Medicine and Rheumatology subspecialist). Some of them are graduates of our


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specialty porgrams; Dr. Olaya returned from Spain after receiving her trainning, sponsored by our institution. Finally, I would like to highlight other porjects completed in 2013 with the porpuse of continuing the provision of servicies of excellence to the community in the years to come:

• Polysomnography - Sleep Clinic for the treatment of sleep apnea; located in Betania, our alternative countryside facility. • Genetic Research Laboratory • Laboratory for Molecular Research and Teaching. • Implementation of integrated bar code for the SAP system. • Medical Appointment system through webpage. Conformal Radiotherapy. Greater local control with decreased side effects on normal tissues. • Contacto Canguro (the name given to our Kangaroo care) and Maternal Breast-feeding. This is a program offering support to the general community in breast-feeding matters and follow up of premature babies after discharge from the neonatal unit.

• Functional Magnetic Resonance Imaging Mapping for the planning of neurosurgical procedures. We hope to continue serving the community with all our institutional resources.

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• Openning of the Ninth Floor for VIP Hospitalization, a space designed to provide comfort and privacy.


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Medical Education Education Department

Tenth semester professor training was done (otolaryngology, ophthalmology, orthopedics, urology and neurosurgery rotations).

Education is one of the fundamental pillars of Valle de Lili Foundation and it continued to develop during 2013. Process growth, improvement and innovation were present in the general and specialty medical education fields for the teaching–service agreement with Icesi University and in the specialty program agreements with CES, Valle and Cauca Universities. Post graduate student rotations continued for ancillary medical care programs (nursing, physical therapy, diagnostic imaging technologists and) under the agreements with the Universities of Valle, Mariana, Fundación Universitaria del Área Andina and Icesi. Furthermore, the scholarship and training support program for healthcare profession is ongoing. The Education Department coordinated the organization of congresses and academic activities held at the Foundation. This division also filed documentation to continue with the University Hospital accreditation process before the Ministry of health. Medical Student Rotations

In 2013, clinical practice for eighth (gynecology-obstetrics) and ninth (surgery) semester students from the ICESI University medical school began. Valle del Lili Foundation admitted the following number of students:

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This process was coordinated by staff physicians who developed the complete program: student practice plans and assignment of classes for the student groups with an active learning methodology. The fifth University Teaching Diploma program was done with ICESI University to continue with professional development and expand this tool among the institution’s teaching body. Arrangements have begun for rotating internships that begin in July 2014 Specializations

In 2013, the first graduates of the School of Medicine, ICESI University completed the program in partnership with Valle del Lili Foundation. These were the first two rheumatologists, second specialty for internists and the first two arthroscopy specialists, the second specialty for orthopedic traumatologists. The hospital actively participated in the student admission and selection for the specialty programs offered at the Foundation along with Universities with which there are teaching-service agreements. Additionally, special rotation requirements were arranged for other specialties. Students by program at the Valle del Lili Foundation in 2013:


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The first Organ Transplant Coordinator Diploma program was taught jointly with ICESI University and four general practitioners were certified. Documentation for the Emergency Ultrasound Diploma course was completed and there will be admissions in 2014.

Additionally, 10 nurses were on rotation for the critical care specialization, 37 physical therapist in the pulmonary rehabilitation specialty and 7 diagnostic imaging technologists. Graduates: 29 physicians receive a title in various specialties with the Universities of ICESI, CES and VALLE as follows:

The objective for 2014 is to work on developing the Allergology, Pediatric Anesthesiology, Transplant Anesthesiology, Pediatric Surgery, Infectious Diseases and Neurosurgery programs. Institutional Académic Activities

In 2013, institutional academic activities continued for physicians, medical and specialty students: • Great Medical Session: an activity presented by a medical professional with extensive experience in matters of general interest. • CPC: an activity arranged by the Pathology Department to correlate clinical and pathological findings. • Molecular biology and clinical case seminars

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The programs for second specialty in Nephrology, Psychiatry, Cardiology and Liaison Psychiatry were designed and these were presented before the Foundation’s Executive Medical Committee and Superior Council of ICESI University. Currently, they are under evaluation at the National Education Ministry and the Foundation expects to receive the approved registrations to begin admissions.


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Alliances with Centers of Excellence

Through the ongoing institutional policy of human resource development at Centers of Excellence for the advancement and strengthening of our own programs, relations were consolidated in 2013 with: • ISN- Sister Renal Center Program Center: Boston Children’s Hospital – Valle del Lili Foundation: various healthcare professionals from the Foundation received training at this hospital. At the fourth Pediatric Nephrology Symposium various professors which were invited also actively participated as conference speakers. • International Pediatric Transplant Association (IPTA): an application was filed for support and training of our human resource. The institution evaluation was done and currently the Foundation is in the process of approval. • Stanford University for the institutional human talent training program in Infectious Diseases. • Pittsburgh University-ICU/Trauma within the Fogarty program. • Children´s Hospital of Pittsburgh. The agreement provides support for developing Pediatric Cardiovascular Surgery and Liver Transplant Centers at Valle del Lili Foundation. • Hospital Ramón y Cajal – Children’s Hospital La Paz, Madrid: Gastroenterology group, Hepatology and Liver Transplant. Cystic Fibrosis Reference center. • Center for the Study of Autoimmune Diseases (CREA), Universidad del Rosario University. Mutual cooperation agreement for the development of research in this area. Courses and Congresses

2013, the institution’s professionals organized courses, congresses and seminars which generated profits for Units’ funds:

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University Hospital Accreditation

Based on the current legal regulations (Laws 100/93, 1122/07, 1164/07, 1438 from 2011 and Decree 2376 from 2010), documentation was prepared to submit the Foundation to the process of University Hospital accreditation. Installed capacity and human talent were updated for teaching at the Institution. Procedures were developed for medical student and specialty practices. An inventory was taken of the research practices of staff physicians, general medicine and specialty students as well as the lines of research and corresponding studies. The research area along with the universities with which there is a teaching-service agreement proposed approaches to strengthen all areas of teaching and research. University well-being was expanded to include the increase in the number of students and professors as well as future projections. General and specialty medicine programs were evaluated together with Valle del Lili Foundation coordinators and professors to improve the practice and teaching of medicine. There were advances in the improvement of student and professor evaluation processes. This completed the documentation for accreditation as a University Hospital before the CONACES Health Sciences Committee of the Ministry of Education. The institution is prepared to receive an evaluation visit from colleagues in 2014.


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Clinical Research Clinical Research Center

In the second semester of 2013, the Clinical Research Center at Valle del Lili Foundation went through relevant structural changes which included new management headed by Dr. Fernando Rosso Suárez. With this and other strategies the objective is to consolidate the center’s standing before the medical community, employees, management and the institution in general. The aforementioned is in line with the objective of ongoing strengthening of alliances with universities, pharmaceutical companies and national institutions such as ICESI,

2013 was a year of great challenges that consolidated institutional research and this was reflected in national as well as international scientific production and attainment of external resources. Institutional research is affected by greater competition for external resources. Furthermore, the amount pledged by various sponsors is now more precise and strict; these are funds granted by non-governmental organizations and of course the State through Colciencias. The research group at Valle del Lili Foundation in 2013 continues to be in Colciencias’ category “A”. Incentive Plan

In December, research incentives were given to physicians that had the greatest participation in this activity during the year, which furthers the institution’s fourth pillar. In total 67 bonuses were awarded to staff physicians and they came to $109,000,000 COP Feasibility Sponsored Research

In 2013, the Clinical Research Center received 156 proposals from the Pharmaceutical Industry interested in Valle del Lili Foundation as a potential center for their studies. Of this, 67 were treated as academic studies or pre-feasibility studies (initiatives to knowthe center in general, not for a specific study). Thus 89 proposals applied to it. Compared to

2012 there was a 75% decrease, this is explained in the administrative imbalance occurred during mid- year and then the new team. Of these 89 proposals to be evaluated, ten protocols began in October, which the annual goal that rules the CIC (minimum number of studies to be carried out per year). Own Research

Throughout the year 45 institutional research studies were received of which 29 were initiated (64%), a balance certainly better than the previous sponsored research. This is due to the greater stability of this type of research, where research comes in and there aren’t actually many factors that determine its continuity in the process. To this is added the interest of institutional physicians to investigate and take forward projects that will bring them support to their respective services. Besides that there isnot the barrier of a budget or financial evaluation. Financial Management

With a variation of the annual budget of 13%, the Clinical Research Center culminated in 2013 healthy finances. After conciliating 16 sponsored studies and settle all accounts it showed with the medical staff, this variation is significantly better than expected. Admission for Sponsored Research $ 420 million COP wasobtained of which, one hundred ninetyone million were retrieved only in the last 5 months. Of this revenue, overdue fees and coinvestigators of researchers was recovered, a benefit for the Lili Valley Foundation is obtained and the yearended with 44% available to the Research Center

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CIDEIM and PROESA


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Social Service Social Investment in Community HealthServices

Attention to Soldiers Wounded in Combat

Amenities in the institution to the underserved population In the Valle del Lili Foundation outpatient services are provided, as well as support diagnosis, treatment and surgery.

The Valle del Lili Foundation provides initial emergency care, surgery and emergency control to wounded soldiers who are brought in by helicopter and ambulances from the battle site.

Another aspect covered by the Social Support Unit is the psychosocial care to hospitalized pediatric patients in the institutionwith different academic and recreational activities offered in comfortable environments such as: • Hospital Classroom: An educational and fun space that integrates the information technology and communication (ICT), stimulating the creative-expressive development, generating welfare and activating the basic instrumental skills. It offers its services to hospitalized pediatric patients on the 4th floor.

• Spinal Cord Brigades: It continued with the

commitment in the care of children with spinal deformities, that’s how in 2013 more than 130 children were valued and 22 patients were

operated. • Operation Smile Brigades: During the days of

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• Happy faces: The Happy Faces program within the framework of social responsibility and humane health care, to improve the quality of life of patients and ensure compliance with the rights of hospitalized children and the right to space and playing time. It is a program in which children are free to play and forget about the disease, Involving children of different ages, from all social strata, from the city, other municipalities, departments and even other countries.

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Gynecology

89 activities were conducted at antenatal teenagers Cermujer Foundation. Prevention and early detection of cervical cancer, 117 smears were taken, and family planning in women victims of sexual violence and femaleheaded households was also made. Financial AID

The Valle del Lili Foundation offers different types of aid for hospitalized patients in the institution. The supply is to help families of low-income patients who accompany the patient permanently.

than 100 children were evaluated and 54 patients were operated. Extramural Brigades

Transportation aid to poor patients is given to help them return to their town of origin. Transportation

Throughout the year various periodic campaigns unprotected organizations serving children and single mothers were made. With the funeral aid the institution helps the family of pediatric patients who due to their delicate health conditions die in the institution and their families do not have sufficient financial resources. Memorial

Dentistry

Throughout the 2013 days of oral health were conducted in different districts of the city, getting 1,636 patients attended.

“Social responsibility through the provision of management services to high complexity disadvantaged populations, according to available resources.”

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Feeding


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Volunteering

The Volunteer brigade of the Valle del Lili Foundation counts on people who generously give their best, in order to help improve the conditions of the patient and family through concrete actions such as accompaniment, counseling, provision of information, identification needs, design and implementation of strategic programs for the critical aspects. Its action is based on the recognition of the dignity, respect for their beliefs and the decisions they make in their life. Its administrative structure guarantees the fulfillment of its objectives, the effectiveness of its activities and the permanence of the Association over time. Comercial Area Report

The year 2013 was a year of favorable results, which allowed continued development programs created to support and benefit the patient and family. Volunteer Programs are funded through:

1. Point of sale “Delicias Palpitar” 2. Palpitar bonds 3. Second hand or thrift shop 4.Donations in cash and in kind by individuals These results are achieved only with work, commitment and effort of all.

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Corporate Social Responsibility The Valle del Lili Foundation and its Environmental Management System, struggle every day to strengthen actions to prevent and mitigate the negative impacts that may be caused to the environment, so it has a purpose of continuous improvement that enables development activities in the framework of the provision of responsible service to users, employees and the environment. Forming an important part of what the Social Responsibility means, the environmental Management System in its efforts to constantly improve and contribute to the integral development of all processes performed different activities and obtained the following results in 2013: • First Meeting Corporate Environmental Responsibility Environmental Committee of Neighbors The 1st Meeting of Corporate Environmental Responsibility, RAE was held at the premises of the Fundación Valle del Lili, on August 29, 2013, which had as its main objective to provide a space for community training on good environmental practices and updating environmental regulations applicable to everyday life and home. During the event, five masters training, each lasting 20 minutes, were scheduled on issues related to: • Corporate Environmental Responsibility • Waste Management in the Home • Postconsumtion Plans (Batteries, Tires, Drugs, Lighting, etc.) • Environmental Subpoena • Domestic Wastewater Contributing to building an environmentally responsible culture from the domestic context, in the context of Corporate Social and Environmental Responsibility, synergy between trade, health, industry, and community authority was achieved. in the context of Corporate Social and Environmental Responsibility, synergy between trade, health, industry, and community authority was achieved, 124 Informe Anual 2013 • Fundación Valle del Lili

contributing to building an environmentally responsible culture from the domestic context. • Graduation of the Third Group of Environmental Auditors Environmental indicators of the Fundación Valle del Lili, are a group of reviewers who voluntarily seek environmental improvement from each work area and contribute with new ideas, methods to protect increasingly environment from their work in the institution, the purpose is to have replicators on good environmental practices in each of the areas of work in the Valle del Lili Foundation. On may 3, 2013. 25 environmental auditorsw graduated, forming the 3rd group of graduates’ auditors. • Green Shopping The commitment of the Valle del Lili Foundation in continuing medical devices that prevent an impact to the environment is reflected in the figures for savings and consumption needleless syringes, easy bathroom, among others. During 2013 the consolidated green purchases by the Fundación Valle del Lili is as follows: Syringes using needle had a reduction of more than 50%, which leaves nearly 1,000,000 generate clean needles as hazardous waste, this in turn prevents unnecessary burning and significantly reduces the occupational risks. NEEDLELESS SYRINGES USED

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Environmental Management System


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Internal processes

In 2013, the Patient Safety Committee continued supporting units and services in the establishment of operational plans related to the internal process perspective in terms of patient safety, and began tracking the deployment of actions set out in Good Practice for Patient Safety as the risk of each unit. • Institutional Campaign / Celebrations in Patient Safety Strengthening of Culture in Patient Safety As part of the strengthening of culture in Patient Safety, the following activities were conducted during the year 2013: Learning activities: Patient Safety orientation (for new staff in the institution), Workshop on Patient Safety and brief sessions Patient Safety (Lectures). Medical assistance for staff. Audiovisual Material in Patient Safety: An audiovisual note addressed to patients and their families about the main risks for the general care and measures to prevent them, which is transmitted through the institutional channel FVL, was performed. An institutional video about the program Patient Safety Foundation in Valle del Lili, in order to reinforce reviewers’ knowledge of institutional policy on patient safety and the strategies implemented in the Organization was also performed. Safety Rounds Group Leader: also kept safety rounds, considered as an important tool in the generation of safety culture, to involve the Branches Medical and Healthcare for its realization.

Safe Use of Patient and Identification: Correct Dial laboratory samples. These bulletins are available on the intranet. Results of Adherence in Practice in Patient Safety: During 2013, the systematic measurement of good practice in Patient Safety was kept on, extending measurement services which had not been intervened, prioritizing measurement of best practices that apply to risk service. The good practices that underwent measurement of adherence were: • Preventing Falls. • Identification of patients. • Drug Administration. • Prevention of pressure ulcers. • Infection Prevention: Prevention of ventilator-associated pneumonia, Central venous Catheter care and peripheral. • Security Protocol in Surgery. • Safety during components.

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• Identification of patient sampling during clinical laboratory. • It is to highlight the steady increase in adherence of caregivers to good practice based on the results obtained in the measurements, reflecting the commitment of all to the safety of patients.

Patient Safety Bulletins: The priority issues for its implementation were: Errors in Medication Administration (distilled water), safe use of infusion pumps, enteral tubes

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Patient Safety

Annual Report Executive Eummary 2013