Annual Report 2010
Design and editing:
Maignon 50, 5Âş 3ÂŞ 08024 Barcelona www.mapadvisers.com
Index Introduction ������������������������������������������������������������������������������������������������������������������� 4 Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Profile of the organization ����������������������������������������������������������������������������������������� 6 Report Parameters ����������������������������������������������������������������������������������������������������� 13 Management, commitments and strategic lines ������������������������������������������� 14 Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Indicators of economic, environmental and social performance������������� 48 Our clients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Index of GRI indicators ��������������������������������������������������������������������������������������������� 51
Continuing along the right way
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Thinking and acting in the key of sustainability
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MĂŠxico D.F. Managua Panama
Sao Paulo Santiago de Chile Caption
Profile of the organization
Gesaworld, S.A. C/ Comte d’Urgell, 204 5èB 08036 Barcelona (Spain) Tel. +34 93 363 03 27 firstname.lastname@example.org www.gesaworld.com
Gesaworld NICARAGUA Gesaworld, S.A. Oficina en Managua Edificio Málaga, planta baja Módulo A-14 Managua (Nicaragua) Tel. +505 266 4314
Gesaworld CHILE, Ltda. C/ Padre Mariano 181, Oficina 404 Providencia Santiago de Chile (Chile) Tel . +56 2 3621504
Gesaworld MÉXICO, S.A. de C.V. Gob. Francisco Fagoaga nº 80 Col. San Miguel Chapultepec 11850 Mexico D.F. (Mexico) Tel. +52 55 5276 5050
Gesaworld PANAMÁ, S.A. Edificio Vallarino, piso 5, oficina A Cls 52 y Elvira Mendez (Área Bancaria) Ciudad de Panama (Republic of Panama) Tel. +507 209 5241
Gesaworld USA L.L.C 1625 I Street NW, Suite 620 Washington, D.C. 20006 (USA) Tel. +1 202 429 20 45
Gesaworld do BRASIL, Ltda. Avenida Paulista, 1499 Cjs. 1106/07/08/09 01311-928 São Paulo (Brazil) Tel. +55 11 3371-3111
Gesaworld PORTUGAL, Lda. Rua de S. Nicolau, Nº 121, 4º andar 1100-548 Lisbon (Portugal) Tel. +351 21 88 79 220
Gesaworld MADRID C/ Génova 15, 3º Ext. Derecha Madrid 28004 (Spain) Tel. + 34 91 308 22 25
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Profile of the organization
Name of the organization
Main brands, products and services
GSW Classroom â€œIn companyâ€? training (classroom and e-learning). Healthcare and management training programs. Accompaniment of executive teams. Professional career and incentives models. Health and sustainability Measuring, design and functional plans for equipment and infrastructure using sustainable criteria. Technological models (telemedicine, digital hospital and clinical information systems). Works management and project management. Sustainable healthcare networks(Carbon Finance, energy models and environmental regulation). Sustainability plans and sustainability certifications. Culture of sustainability and communication. Studies to raise finance for sustainable projects. Programs and public policies Planning, development and evaluation of public policies. Observatory for the health and social sector.
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Healthcare models: primary and hospital care, public and community health. Attention to dependency and social services. Financing: analysis of insurance models and Public-Private Partnership (PPP) schemes. Institutions and health centers Strategic and functional planning. Healthcare protocol and reorganization of processes. Audits, evaluation and analysis of complexities (economic, organizational and healthcare). Interim management in management contracts. Quality management (evaluations, models and certifications). Decision support models (scoreboard and key indicators). Information Systems (functional designs and change management).
Profile of the organization
Operative structure of the organization, including main divisions, operational entities, subsidiaries and joint ventures
Localization of the main headquarters of the organization
Countries in which the organization operates and the countries in which it carries on significant activities or which are specifically relevant in terms of the aspects of sustainability dealt with in the Report
Corporate structure President: Joan Castillejo CEO: Josep Lázaro General Director: Roser Vicente Assistant General Director: Javier Esteras Economic-Financial Director and Director of Corporate Projects: Josep Maria Martínez Technical Director: Montserrat Dolz Director of Strategy and Development: Marc Satorrass
The central offices of the Gesaworld Group are situated at 5º B number 204 calle Comte d’Urgell in the city of Barcelona, Spain.
The group has offices in Spain (two), Portugal, United States, Mexico, Nicaragua, Panama, Brazil and Chile and it develops significant activities in Costa Rica, Belize, Honduras, El Salvador, Guatemala and Colombia
Territorial division · Brazil · Central America, Caribbean and Andean Region · Mexico · Chile · Spain · Portugal · United States
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Profile of the organization 2.6
Nature of ownership and legal status
Gesaworld S.A., which was founded in Barcelona in 1999, is the parent company of the corporation. It controls all the activities around the world. From its early days, Gesaworld opted to create separate companies in the countries in which it is very active so that it could offer the best possible service to its clients. This policy has resulted in the creation of Gesaworld do Brasil Ltda., Gesaworld MĂŠxico, S.A. de C.V., Gesaworld PanamĂĄ S.A., Gesaworld Chile Ltda., Gesaworld Portugal Lda. Y Gesaworld USA L.L.C., all of which operate around Gesaworld S.A.
Throughout its eleven years of existence, the Gesaworld Group has worked for more than 90 clients in 19 different countries: Spain, Portugal, United States, Nicaragua, Canada, Belize, Honduras, France, Costa Rica, El Salvador, Panama, Colombia, Brazil, Paraguay, Chile, Morocco, Guatemala, Dominican Republic and Mexico (see map on page 6). The main clients of the company are: public administrations, international organizations, health institutions, private companies, universities and training centers.
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Profile of the organization 2.8
Size of the organization Number of employees: 76 Quantity of products or services provided: 35 projects carried out.
Evolution of equity
In terms of the total figure for (equity + liabilities)
millions of euros
60 % 10
30 % 29.17 % 20 %
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Profile of the organization 2.9
Significant changes during the period covered by the Report
Evolution of equity
millions of euros
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The company opened new offices in Madrid in mid 2010. At the end of the same year, Gesaworld USA L.L.C, was established as the delegation of the company in the United States, and it has its headquarters in Washington DC.
Report Parameters 3.1
Period covered by the information contained in the Report From 1 January to 31 December 2010
Date of the most recent previous Report From 1 January to 31 December 2009
Cycle of presentation of Reports Yearly
Contact for matters relating to the Report and its content Marta Garriga: email@example.com firstname.lastname@example.org
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Management, commitments and strategic lines 4.1 1.
Governing Structure of the organization Board of Directors Joan Castillejo (President) Josep Lázaro (CEO) Roser Vicente (CEO) Josep Maria Martínez (Secretary) Albert Tarrats (Director) Montserrat Dolz (Director)
‣ Strengthen the region of Central America: new sectors. ‣ Brazil: maintain our leadership position in the health sector ‣ Europe: within context of reforms, consolidate client portfolio. ‣ United States of America (USA): consolidate this market.
Steering Committee Joan Castillejo (President) Josep Lázaro (CEO) Roser Vicente (General Director) Javier Esteras (Assistant General Director) Josep Maria Martínez (Economic-Financial director) Albert Tarrats (Director) Pedro Nueno (External adviser)
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Strengthening of the lines of action and generation of new products ‣ Health and sustainability: development of new products. ‣ Information and communication technologies. ‣ Public Policies and Management. ‣ New platform for knowledge and innovation. ‣ Corporate Social Responsibility (CSR): based on the Gesaworld network, Innovation, Organization and Human Capital.
Strategic lines The central objectives of the strategic lines of Gesaworld S.A. for the period 2011-2012 are reaching sustainable development, strengthening new lines of action and generating new products, consolidating the organization and strengthening the technical prestige and the projection of the company. These lines mark the strategic direction of the company and they are completed by a series of guidelines and perspectives that are the result of the thoughts shared by the management teams. We will now give a summary of the main strategies to be followed over the next few years:
Consolidated Organitzation ‣ Strengthening of the territorial organization. ‣ Professional career. ‣ Regional and local management structures.
Technical prestige and projection ‣ The Brand Plan: The essence of Simplification. ‣ Internal Communication Plan. ‣ Collection of Publications “Themes for knowledge and analysis”. ‣ Gesaworld 2.0
Management, commitments and strategic lines 4.13
Gesaworld is a member of the following associations
European Public Health Association
Universidad de las Regiones Autónomas de la Costa Caribe Nicaraguense
Cámara Oficial Española de Comercio de Panamá
College of American Pathologists (CAP) division SNOMED
Asociación Española de Economía de la Salud
Associação Portuguesa de Engenharia e Gestão da Saúde
Unió Catalana d’Hospitals http://www.uch.cat
Health Technology Assessment International http://www.htai.org
Green Building Council Panama http://www.panamagbc.org
Círculo de Economía
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Projects 2010 Analysis of the Impact of the European Space for Higher de Education at Bellvitge University Hospital
Impact evaluation: Community-based Integrated Child Care Program (AIN-C)
Evaluation of the situation of sustainability at the centers of the Catalan Union of Hospitals
External technical auditing of the strategy to extend coverage through the provision of the PAISS+N and the PSPV
Functional plan for the new General Hospital of Granollers Day Hospital - Santo Tomás Hospital Patient safety projects in Catalonia Organizational diagnosis and proposals for a model for the management of the processes related to teaching and the professional stays at the Mar Health Park Consortium Strategic Plan of the Medical Emergency System (SEM) Revision of the Functional Plan for Caceres Hospital (Phase II) Study and analysis of “expert patient” initiatives Market study of the flow of International Health Tourism patients in Spain Implementation of the EFQM model at Faro Hospital Technical support for the UMCCI and training in the development of Palliative Care in Portugal Study of the economic impact of the application of the EU Directive on Cross-border Healthcare on the Portuguese National Health Service
Computer Management Plan of the São Paulo Municipal Secretariat for Health Advice on the Public-Private Association Project to modernize the hospitals of the São Paulo Municipal Health Secretariat Program Contract: a model for the management of hospitals through a new contracting concept based on performance indicators System for the management of Hospital Information (SGIH) Methodology and support for the introduction of the AME model in the health system and integration of healthcare levels Mirror Contract: Study for the introduction of a new methodology for financing the hospitals administered by Social Organizations in Health (OSS) of the basis of productivity indicators
Strengthening of mother and child healthcare in Morocco
Project for healthcare coordination and integration of health services
Consultancy for the formation of a consensus on the diagnosis and strategy of the Reform of Mercantile Legislation in Nicaragua
Methodology for contracting by objectives and monitoring of the results of the hospitals of the municipality of São Paulo
Consultancy for the social analysis of the “Hurricane Felix Recovery Project”
Technical and operational support for the implantation of new models for contracting health services
Projects Analysis of the Impact of the European space for Higher Education at the university Hospital of Bellvitge
Evaluation of the situation of sustainability at the centers of the Catalan Union of Hospitals
Localization: Barcelona, Catalonia (Spain) Client: Catalan Health Institute (ICS) Objective: Prepare a Study to analyze the impact of the European Space for Higher Education (EEES) at Bellvitge University Hospital and prepare a diagnosis of the situation. Development: Gesaworld carried out this project together with the Chair in Health Management, Direction and Administration at the Autonomous University of Barcelona to improve teaching in Health Sciences. The project includes a diagnostic analysis of the current situation with regard to human resources, the teaching methodology used, the areas set aside for teaching, technological support and internal organization. The aim was to introduce proposals for improvements that would be prepared at Bellvitge Hospital within the area of Primary Health Care at the Faculty of Medicine (UB) and at the School of Nursing (UB)in order to successfully meet the challenge of the Bologna reforms. A mixed study was designed to achieve these objectives and this study included quantitative techniques and qualitative techniques for gathering data from a representative sample of subjects and studies involved. The introduction of the EEES reinforces the role of care institutions that participate in learning processes, and accordingly it represents a quantitative and qualitative approach to the challenges of the new European scenario for the teaching of Health Sciences.
Localization: Catalonia (Spain) Client: Catalan Union of Hospitals (UCH) Objective: To understand the situation of sustainable development in a number of Catalan hospitals. Development: Gesaworld initiated this study with the intention of making it an annual event and with the aim of obtaining a diagnosis of the situation of sustainable development at the hospital centers attached to the Catalan Union of Hospitals. The methodology used included the creation of an online survey that focused on various areas of the hospital (sustainable policy and organization, healthcare practice as well as general and support services). Four hospitals representing the different types of hospital that form part of the UCH were invited and these participated in the pilot test. The test was subsequently extended to the 36 hospitals that were finally the target of the study. The results were presented at an act held at IESE Business School in January 2011. This project is hoping to become the first step in the constitution of an international observatory on sustainability within the health and social sector, so as to bring together the best practices, trends and advances within this area.
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Projects Functional plan for the new General Hospital at Granollers
Localization: Granollers, Catalonia (Spain) Client: Hospital Asilo de Granollers Foundation (FHAG) Objective: Prepare the functional plan of the new Granollers General Hospital. Development: Gesaworld drew up the functional plan for the new Hospital, which includes new concepts and new design trends and operational tendencies for modern hospital centers. Concepts such as digital hospitals, telemedicine, high resolution consultations, integrated services and inter-center cooperation are some of the aspects that have a prominent place in this plan. This project also places special emphasis on the “sustainable hospital” concept. The work include determining healthcare needs, reviewing functional measuring, making proposals for the organization and functioning of the units, proposing circuits and relations between areas, making proposals for organizational and technological provisions with details as to how to implement these, making proposals about how to arrange and endow each area and the spaces that determine the functional measuring, defining the typology of the centre, the healthcare model, the level of resolution and the relations with the health network of which it is a reference. Finally, the project offered a proposal of measures to be taken in the new infrastructure based on “Green Hospital” or sustainable hospital guidelines.
Patient safety projects in Catalonia Localization: Barcelona, Catalonia (Spain) Client: General Sub-Directorate of Health Services. Department of Health, Autonomous Government of Catalonia(Generalitat de Catalunya) Objective: Provide methodological support services to promote a space to reflect on work lines for patient safety throughout the health system. Development: An analysis was made of the “Register of projects on patient safety” and technical advice was provided for the development of the workshop and accompaniment of the SGSS team (General Sub-Directorate of Health Services) in order to come up with the strategic work lines for patient safety in Catalonia based on the results of the workshop. More than one hundred professionals from the various service lines (Primary Care, health and social, hospital, mental health and addictions) working within Patient Safety attended this work session. The workshop offered an opportunity to reflect on the work lines for the whole of the health system with regard to matters of patient safety and to elaborate a strategic framework which could provide content and continuity within this area in the short and medium term.
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Projects Organizational diagnosis and proposal for a management model of the processes related to teaching and professional stays at the Mar Health Park Consortium
Localization: Barcelona, Catalonia (Spain) Client: Mar Health Park Consortium Objective: Make an organizational diagnosis and a make a proposal for a management model of the processes related to teaching and professional stays at the Mar Health Park Consortium. Development: This project contemplated several objectives: support for the Teaching management at the Mar Health Park in order to reach the objectives established for the year; advice in preparing the process for the evaluation of the accredited services for the training of Resident Physicians (MIRs), carried out by the Quality Agency of the Ministry of Health and Consumption; provision of advice on how to make an organizational diagnosis and offer a proposal for a management model for the processes related to teaching and the professional stays at the Consortium. A hospital complex such as the Mar Health Park receives a large number of students and professionals, who come each year to train and to bring their knowledge up to date. The design of the circuits, processes and instruments carried out by Gesaworld has allowed this institution to strengthen the services it has to offer within an area as important to hospital activity as teaching.
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Strategic Plan of the Medical Emergency System (Sistema dâ€™EmergĂ¨ncies MĂ¨diques) Localization: Catalonia (Spain) Client: Medical Emergency System (SEM) Objective: Prepare a situational diagnosis and a strategic plan for the Medical Emergency System. Development: The SEM initially grew out of the Service for the Coordination of Medical Emergencies (SCEM) pilot program in 1985 as a public company to deal with health emergencies, and it has progressively increased its complexity and broadened its portfolio of services. For this reason, it was necessary to carry out a review and strategic analysis of the entity. Gesaworld offered its experience and its knowledge of the Catalan health system and guided the project towards the translation of the mission and vision to an organizational model, in order to optimize the resources and, especially to facilitate the management and the evolution of the organization in the face of current and future challenges. One of the main challenges involved highlighting and evaluating the pros and cons of several future scenarios, in such a way that the entity could establish a roadmap to help guide its towards the desired situation.
Projects Revision of the Functional Plan for Caceres Hospital (Phase II)
Study and analysis of “expert patient” initiatives
Localization: Merida and Caceres, Extremadura (Spain) Clients: Extremadura Health Service Objective: Prepare an analysis of the needs of Caceres Hospital and revise the enlargement needs of Phase II of the New Caceres Hospital and also act as an advisor in the adjustment of indicators, which will help to plan the real offer and demand of the service provided and the corresponding repercussion on the measuring of the enlargement. Development: The aim of this work is to review Functional Plan, Phase I, and to make an analysis of the needs identified for Phase II of the Functional Plan of Caceres Hospital, which is still under construction. To achieve this, interviews were held with managers and those in charge of health at Caceres Hospital and there was also an analysis and a projection of expected supply and demand at the centre. The process includes a review, analysis and validation of the portfolio of services. An analysis and validation of the measuring and of the hospital spaces was then carried out in order to finally prepare a plan of adjustments for Phase II, and a specific report of recommendations for the hospital was also prepared. Furthermore, Gesaworld prepared a report on trends that included information on new management models and new technologies for the hospital. The analysis of the Functional Plan and the conclusions and recommendations deriving from the same were set out and validated with both the Extremadura Health Service and those in charge of Caceres Hospital.
Localization: Vizcaya, Basque Country (Spain) Client: BIO Eusko Fundazioa – Basque Foundation for Health Innovation and Research Objective: Analyze the “expert patient”, initiatives aimed at promoting self-care of patients in Spain and in the rest of Europe. Development: This work involved investigating and analyzing the “expert patient” initiatives carried out both nationally and in the rest of Europe for the purpose of offering advice on the orientation of the program carried out by the client. Once the initiatives had been identified, research work was carried out on each of them through the design of questionnaires for those in charge of the initiatives and through telephone monitoring designed to obtain more information and documentation in this regard. Subsequently, detailed descriptive records were prepared to analyze all the initiatives and these looked at aspects such as the methodology used, the course materials, advertising/communication support, quality evaluation and the results of the courses on offer, mechanisms to maintain contact between patients or contact information, to mention just a few. Finally, the client was given a table summarizing the most relevant initiatives, with an emphasis being placed on the key aspects of each.
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Projects Market Study of the flow of International Health Tourism patients in Spain
Localization: Pamplona, Navarra (Spain) Client: University Clinic of Navarra and Navarra Chamber of Commerce and Industry. MODERNA (Strategic Plan to define a New Model of Economic Development for Navarra in the medium and long term) Objective: Provide the client with information on the movements of patients and on health tourism, fundamentally focused on demand at both a national and an international level. Development: The analysis was carried out in two phases and the object of study was clearly differentiated. During Phase zero - “Analysis of the movements of patients in the national area” – there was an analysis of potential patients and the portfolio of services (demand) within the national territory for Navarra. This phase included an analysis of the evolution of the epidemiological profile at a national level by autonomous communities, and an analysis of the flow of patients, also at a national level, by autonomous community and, specifically, for the case of Navarra. There was also an analysis of Waiting Lists and their evolution over the past few years and the most demanded services and processes in 2010 at both a national and an autonomous community level. Gesaworld prepared a dynamic tool using the information gathered to analyze and calculate potential demand and income and this was then used to create a 22 | Gesaworld Annual Report 2010
ranking of the services that were most in demand by patients and the potential income by autonomous community, and at a national level. The study also included a ranking of positioning and quality as perceived by patients. During Phase 1 “Market Study and Analysis of Trends. International Level”, research work was carried out and specialized information was gathered and this provided a response to the questions posed by the client: magnitudes, trends, channels and the medical specialities that are most in demand at an international level. Accordingly, the study encompassed different aspects, such as an analysis of the main magnitudes of influence in health tourism at an international level, market trends and statistics, an analysis of supply and demand for international health tourism, an analysis of the medical specialities and destinations most in demand and price ranges, as well as the main channels and operators for health tourism or associated trips, certifications and quality as well as several others.
Projects Technical support for the UMCCI and training in the deImplementation of the EFQM model at Faro Hospital velopment of Palliative Care in Portugal
Localization: Faro, Portugal Client: Faro Hospital Objective: Implement a quality model for the hospital based on the EFQM global model. Development: The project introduces the bases for the development of a model for global quality management, through the creation of a quality team at the Hospital and the holding of training workshops and coaching activities to implement the model. An initial self-evaluation was carried out as part of the project, and this was based on an analysis of the organization, its processes and results, which made it possible to identify the weak points and prepare plans for improvements. The application of the EFQM model includes integration within a broader management focus than previous models that have been implemented at the Hospital, such as the ISO regulations. The project included training sessions and visits to hospitals in Catalonia, which have many years of experience in the application of the model to favor the interchange of experiences and knowledge of realities where the application of models of quality constitutes a transversal instrument in the work processes.
Localization: Lisbon, Portugal Client: Unit Mission for Integrated Continuous Care(UMCCI) Objective: Reinforce the implementation of Palliative Care in Portugal through: the preparation of national strategic lines to develop it over the next three years, define a system of indicators and targets to be reached and the organization of training and benchmarking activities to strengthen the competence of professionals. Development: Gesaworld provided support for the Unit Mission for Integrated Continuous Care (UMCCI) in the preparation of a Strategic Plan for Palliative Care, which will be developed in Portugal over the next three years. The implementation of this Plan involves concurrent monitoring using indicators and targets, which were defined by Gesaworld as part of this project. At the same time, more than sixty professionals received training in the organization of care at sessions that focused on the leadership skills of the palliative care teams. National benchmarking sessions were also conducted with teams providing palliative care to achieve a common vision of the organization, its functioning and the work carried out by the teams. The results of the benchmarking process were presented at a national level before an a auditorium of more than 200 persons. The WHO Collaborating Center for Palliative Care participated in this project and it also provided advice.
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Projects Study of the economic impact of the application of the EU Directive on Cross-border healthcare in the Portuguese National Health System
Strengthening of mother and child care in Morocco
Localization: Lisbon, Portugal Client: Central Administration Services of the Ministry of Health(ACSS) Objective: Study the economic impact of the application of the EU Directive on cross-border health-care in the Portuguese National Health Service. Development: The coming into force of the EU Directive on cross-border healthcare, passed in the European parliament in January 2011, resulted in the creation of a new EU market of access to health services and goods with new rules of competition between the different European health systems. The project carried out by Gesaworld studied the impact of the opening up of the internal market to providers and the demand of health services, in both the public and the private sector. Demand projections were made, based on the premises of access determined by the Directive, including gatekeeping and prior authorization systems, and the impact was calculated in economic terms. The strategies required to guarantee the adaptation of the planning of the supply of services, their modernization through the implantation of ehealth, patient safety and the economic-financial sustainability of the Portuguese national health system were identified.
Localization: Rabat and Tetuan (Morocco) Client: Clinical Foundation for Biomedical Research (FCRB) Objective: Make an intermediate external technical evaluation of the Agreement for Strengthening the National Health System of Morocco signed by the Clinical Foundation for Biomedical Research (FCRB) and financed by the Spanish Agency for International Cooperation and Development (AECID). The main objective was to reduce the level of morbi-mortality in Morocco caused by contagious, maternal and perinatal diseases. Development: The execution of the work is based on a preliminary analytical study of the documentation generated by the project. The field work was then carried out using a control panel for the evolution of the execution of the evaluation instruments organized by objectives, results, activities and indicators according to the three main basic components of health systems: research, care and training. Finally, a FODA analysis helped to determine the main internal and external aspects that might help or hinder the development of the Agreement, making it possible to select the strategies that had the greatest impact and viability for the achievement of the strategic objectives.
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Projects Consultancy for the formation of a consensus on the diagnosis and the strategy for the Reform of Mercantile Legislation in Nicaragua
Consultancy for the social analysis of the “Hurricane Felix Emergency Recovery Project”
Localization: Managua, Nicaragua with consultancy activities extended to the Departments of Estelí, Granada, Matagalpa, Jinotega, Carazo, Chontales, Autonomous Region of Atlántico Norte (RAAN) and the Autonomous Region of Atlántico Sur (RAAS) Client: Nicaraguan Ministry of Development, Industry and Commerce (MIFIC) and Steering Committee for the Project for the Harmonization and Modernization of the Mercantile Legislation made up of: MIFIC, Higher Council for Private Enterprises (COSEP), Ministry of Finance and Public Credit (MHCP) and the Nicaraguan Chamber of Commerce (CACONIC) Objectives: Design, facilitate and give advice to the Executive Committee of the Project (MIFIC, COSEP, CACONIC and MHCP) for the execution of a process to form a consensus on the diagnosis and the strategy for the Reform of Mercantile Legislation in Nicaragua. Development: This project consists of: designing a plan of action and a calendar of consultations for the consensus of the diagnosis and the proposal for a strategy to reform mercantile legislation; facilitating the process of consensus of the diagnosis and of the proposal for a strategy between the key actors for mercantile reform in Nicaragua; systematization of the contributions to the diagnosis and the strategy for the reform; designing inter-institutional collaboration agreements to be signed by the key actors of the reform and the Steering Committee of the Project supporting the strategy for mercantile reform; facilitating technical seminars with the key actors of the reform and drafting the final consultancy report.
Localization: Autonomous Region of Atlántico Norte (RAAN) covering the municipalities of Waspam, Puerto Cabezas, Siuna, Bonanza and Rosita. Nicaraguan Caribbean Coast (Costa Caribe) Client: Executive Secretariat of the National System for the Prevention, Mitigation and Response to Natural Disasters (SE SINAPRED) and the Regional Government of the Autonomous Region of Atlántico Norte (GRAAN) Objectives: Evaluate the social aspects related to the execution of the “Hurricane Felix Recovery” project concerning its components and subcomponents up to the date of its execution in 2010, make an analysis of the risks of the project and make recommendations to comply with World Bank policy on indigenous people and the execution thereof. Development: This initiative included the identification and characterization of the communities where the project is being developed; an analysis of its social viability; an evaluation of the fulfillment of the policies for indigenous people established by the World Bank with a focus on fairness and gender equality; identification of social risks; recommendation of an action plan to mitigate of risks and mechanisms for the execution and improvement of community participation to speed up the execution and the achievement of the objectives; the gathering and collection of information at the heart of the communities involved in the project through a representative sample and social-cultural instruments to collect this information; open and structured interviews with key actors and the drafting of the Social Evaluation report.
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Projects Impact evaluation: Community-based Integrated Child Care Program (AIN-C) Localization: Republic of Honduras Client: Ministry of Health of the Republic of Honduras/ World Bank Objective: Carry out a population survey to show the impact of the AIN-C Program, aimed at improving the health and nutrition of mothers and children in the poorest communities of the country using activities for prevention and the transfer of knowledge. Development: The external evaluation measures the impact that the AIN-C has on the population that benefits from the program in terms of malnutrition, acute kidney injury, diarrhea, anemia and mortality; breast-feeding and complementary feeding practices; knowledge and health practices in children and mothers and use of indirect health services. The project started in September 2010 and will continue for a period of 18 months, during which three field surveys will be carried out. The first survey was done between November and December 2010 and 13,285 surveys of mothers, health monitors and community leaders were conducted during this first stage. The surveys looked at weight, height and blood hemoglobin levels to identify the biological impacts of the program on children under the age of 2. The first information gathered involved the mobilization of 80 persons including supervisors, anthropometrists, digitizers, pollsters, itinerant groups, drivers, technical advisers and logistical support. Personnel were involved in information analysis, management, sampling, systems, support and there were also advisers and administrative assistants.
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Projects External technical audit of the strategy to extend coverage through the provision of the PAISS+N and the PSPV
Localization: Panama Client: Ministry of Health of Panama MINSA as part of Agreements N°7587-0 PA and 7479-0 PA with the IBRD Objective: Verify and issue an independent professional opinion on the fulfillment of the technical and administrative management of the strategy to extend coverage (PAISS+N and PSPV). Development: This project was conceived as an integrated technical and administrative-financial audit process for the provision of health services within the framework of a strategy to extend coverage with different methods for providing benefits. It is not a classic accounting or financial auditing model, but rather it is an innovative model of a combined application of supervision tools for health services using administrative and financial auditing tools. “Population groups” are the minimum unit of observation for the consultancy. The Strategy to Extend Coverage contemplates the delivery of health services for a total of 79 population groups assigned to two types of providers: Extrainstitutional Organizations (OE) of a private nature and public providers who operate through what are known as Institutional Tours or Giras Institucionales (GI).
Accordingly, the actions of the consultancy contemplate a multiplicity of actors, service modalities and territorial reach at three basic levels of verification: • A first level limited to the verification of secondary sources (reports, database reports, etc.) • A second level consisting of primary source records (clinical files, registration files, accounting entries etc.) • A third verification level involving the actual persons who benefit from the services provided (members of the basic health teams, management teams, among others) These three verification levels involve the convergence of techniques and instruments for the gathering, validation and analysis of information that report the processes necessary to guarantee the execution of the EEC by the providers. This ensures that the technical and administrative management is done in accordance with what is established in the official documents of the strategy and in strict adherence to regulations and internationally accepted parameters on matters of audits, together with a formative vision, which allows the operation to continue improving. 27 | Gesaworld Annual Report 2010
Projects Computer Management Plan of the São Paulo Municipal Secretariat for Health
Localization: Panama City, Republic of Panama Client: Santo Tomás Hospital Objectives: Design and implement a new method for the provision of specialized daytime services in order to create a day hospital at the Santo Tomás Hospital as an alternative to conventional hospitalization and with an impact in terms of improving patient management. Development: The project is being developed within the area of operative planning in such a way that the products and results obtained are in themselves inputs for the implementation of the new mechanism. By their very nature, Day Hospital mechanisms are characterized by the fact that they are flexible, adaptable and that they develop over time. This aim of this project is to get the most suitable and feasible starting option depending on the characteristics and care needs of the Santo Tomás Hospital in order to be able to develop a short term implantation process for this new type of device.
Localization: São Paulo, Brazil Client: PRODAM – Data Processing company of the Municipality of São Paulo Objective: Evaluate the level of computerization of the São Paulo Municipal Secretariat for Health. Development: The project is based on the study of three elements: the information systems currently being used, the needs of the areas studied as far as information systems are concerned and their interactions with internal and external systems. A joint study carried out with the São Paulo Municipal Secretariat for Health, was used to prepare a spreadsheet of the needs of the Secretariat in order to know the situation of the existing information systems, and to develop a proposal for a functional Information and Integrations Systems model. Finally, an action plan was drawn up to implement the proposed model.
Day Hospital - Santo Tomás Hospital
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Advice on the Public-Private Association Project for the modernization of the hospitals of the São Paulo Municipal Secretariat for Health
Localization: São Paulo, Brazil Client: São Paulo Municipal Secretariat for Health Objective: Develop the overall advice for the technical definition of the PublicPrivate Association project (Parceria Público-Privada or PPP) for the modernization of the hospitals of the São Paulo Municipal Secretariat for Health. This project is the greatest Health PPP undertaken within the international arena. Development: Gesaworld designed and defined a project of public-private participation which will allow the introduction of a level of excellence in the health services of the São Paulo the Municipal Secretariat, which had never been achieved up to now. The project is the first PPP to incorporate sustainability criteria. It considers these criteria not only in the design and execution of the maintenance work of the same, but also takes them into consideration in the equipping and management of noncare services. In this way, the aim of the entire project is to obtain a certification in sustainability for both the planning and the subsequent management of the project.
The new hospitals were designed incorporating the new technologies and the medical advances and services necessary to facilitate clinical efficiency. On the other hand, the enlargement of the productive capacity, the improvements in the functionality of the design of the hospitals and the efficiency in the new models of medical services will make it possible to attend to the population in a broader, more effective and more accessible way. It should also be pointed out that quality evaluation is a constant in the provision and remuneration of services and that the studies carried out by the Gesaworld economic team have reliably established the bases for the subsequent development and financial model of the PPP. Furthermore, the quality axis have been clearly incorporated right from the planning, bidding, contracting and payment of the project up to the end of the period of validity of the PPP. The scope of the project, with a legal model for administrative concessions, includes the complete bidding process and the construction of three new hospitals, four medical imaging diagnosis centers of reference, the complete reform of three hospitals, the complete substitution of six already existing hospitals and the provision of the non-care services that make the correct functioning of the centers possible, both for the medical teams and for the correct care of clients. These services are: sterilization, laundry, hospital cleaning, maintenance of medical teams, maintenance of computer systems, building maintenance, hospital catering, admissions and reception, telephone service and security and surveillance. Gesaworld developed and defined the project in close collaboration with all the institutions involved in the PPP, whose effective coordination is the responsibility of the Society of Public Associations(SPP) of São Paulo City Council.
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Projects System for the Management Hospital Information (SGIH)
Localization: São Paulo, Brazil Client: São Paulo State Secretariat for Health Objective: Provide consultancy services and ongoing advice for the implantation, extension and consolidation of the Contract Program in the directly-managed hospitals that depend on the São Paulo State Secretariat for Health (SES). Development: This project is focused on improving and modernizing the management and the results of the hospital units and developing a new method of relations between the central level of the SES and the directors and administrative teams of the hospitals. The Contract Program incorporates the introduction of performance objectives as well as a system of indicators and a methodology for accompaniment and evaluation, which allows the results to be revised. The project encompasses several work lines, which include the following: the design of models and the content of the program contracts; the development of tools to support the control and evaluation of results; guidelines and the definition of objectives for each hospital; the incentives model for the results; the preparation of a situation diagnosis for each hospital; the training and preparation of the hospital teams; support for adjusting the hospital processes; the evaluation of the indicators obtained and actions based on these indicators; the direct accompaniment of the hospitals in the first six months of the implantation of the contract program and the evaluation of results and proposals for improvements and adjustments for 2011. 30 | Gesaworld Annual Report 2010
Contract Program: a hospital management model using a new contracting concept based on performance indicators
Localization: São Paulo, Brazil Client: PRODAM – Data Processing company of the Municipality of São Paulo Objective: Carry out a study on the current situation of the information systems of ten hospitals and an emergency (Pronto Atendimento) clinic unit of the municipality of São Paulo. Development: The study made it possible to define an ideal model of information system that can cover all the information and integration needs with the external systems of all the areas studied. This project includes a report on the data gathered, the definition of an ideal model with the requirements for the Hospital Information Management System (SGIH), the proposal for an implantation strategy and the contracting model for the SGIH, a study of the profiles of the supplier companies of the SGIH, as well as an evaluation of what type of model - centralized or decentralized - is most suitable.
Projects Mirror Contract: Study for the implantation of a new financing methodology for the hospitals administered by Social Organizations in Health (OSS) based on productivity indicators
Localization: São Paulo, Brazil Client: São Paulo State Secretariat for Health Objective: Improve the process for contracting clinic services by the São Paulo State Secretariat for Health. Development: The project, which includes 40 AMEs (Specialist Medical Clinics) is based on the characterization of a clinical unit carried out by Gesaworld in 2009. This characterization is used to present a portfolio of services and improvements in the current system of payment beyond objectives and clinical indicators. The tool that Gesaworld has proposed for integrating the AMEs into the network is the High Resolubility Assistance Line (LCAR). This work method allows the patient’s entire healthcare history to be expressed and agreed, from the moment that he or she leaves the Basic Care unit up to the conclusion of his or her diagnosis and treatment at the service of reference, within ten priority pathologies. During 2009 and 2010 45 LCARs were implemented in 30 AMEs.
Localization: São Paulo, Brazil Client: São Paulo State Secretariat for Health Objective: Provide the São Paulo State Secretariat for Health with some lines of reflection for possible improvements and the development of a central instrument related to the Social Organizations in Health (OSS) and the university hospitals contracted. Development: First of all, a comparative analysis was made between the different contracts of the OSS, comprising a total of 23 hospitals, in order to get to know the conditions of the payment system at that moment. The aspects for short term improvements aimed at balancing the contractual conditions between the different centers were identified using this method. In this way the results obtained up to now have been improved by adapting the content of the current contracts and payment systems, and support strategies were outlined for the evaluation of the management contract objectives. Two studies were carried out within this project. The first is centered on the situation of each hospital and on a comparison between its prices, costs and activities produced within the hospitalization area. The second study used the results obtained from the productive levels of the hospitals analyzed and involved constructing possible scenarios to improve the productivity in each hospital through two simulation exercises. The controlled changes covered modifications in the variable part of the current payment system.
Methodology and support for the implantation of the AME model in the health system and integration of healthcare levels
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Projects Methodology of contracting by objectives and monitoring of the results of the hospitals of the municipality of São Paulo
Localization: São Paulo, Brazil Client: São Paulo Municipal Secretariat for Health and Social and Health Organizations Objective: Achieve an improvement in the quality of the health systems in certain regions of the municipality of São Paulo. Development: A situational diagnosis was made, which identified the strengths and weaknesses of the quality of the care and a care coordination project was established as a strategy to provide solutions to the critical questions that had been identified. This project involved basic health units (Primary Care), medical clinics (Secondary Care) and hospitals (Tertiary Care) and consolidated the description and support for the structuring of integrated health networks at a territorial level. Some fundamental bases were developed for the construction of the health networks using technical advice, training and the production of knowledge. These include the coordination of the care and the continuum and quality of healthcare. Guides were prepared using a methodology that contemplates coherent dialogue and the evaluation of the real situation of the territorial model of care for the actors involved in providing direct care to the user. These guides make up the dimension of clinical protocols, standard operational procedures and devices regulating access between care levels, and an integrated series of actions for prevention, promotion, care and rehabilitation to deal with the priority health problem. The project includes the evaluation of indicators for processes and results for the purpose of measuring the impact of the care on users with the implantation of the clinical guides.
Localization: São Paulo, Brazil Client: Autarquia Municipal Hospital (AHM) Objective: Promote improvements in the hospital management, resources, results, the flow of information and the normalization of hospital indicators. Development: This project has promoted the development of a new strategy for relations between the public administration and the directors of hospitals through a new management model. This new model looks for best practices through an improvement in hospital performance with an increase in the productivity and the quality of the care. Initially, an analysis was made of the entire structure of the Autarquia Municipal Hospital (AHM), identifying the main aspects and their functions, observing functional reorganization opportunities to improve management and with the support of strategic levels of hospital planning and management. Four hospital units participated in the projects, which have been monitored for a year, with quarterly evaluations of the results according to structural indicators for evaluation and development. The main results achieved have seen improvements in the quality of the information, the structural organization of the work flow, the responsibility of the team in relation to the results, greater control of the quality indicators and the creation of protocols for the normalization and improvement of processes.
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Project for healthcare coordination and the integration of health services
Localization: São Paulo, Brazil Client: São Paulo Municipal Secretariat of Health and Social Organizations in Health Objective: Collaborate in the project for modernizing management starting with the development of a new model for contracting health services which separates the functions between public bodies and non-profit making entities, known as Social Organizations in Health (OSS). Development: Gesaworld participated from the start in the process for the preparation and development of the contracting system for health and social services within the field of primary care, specialized care, hospital care, the Pronto Socorro Municipais (municipal emergency hospitals), medical imaging diagnosis, purchases and supplies. A technical review of the accompaniment indicators for each modality of health service contracted was carried out as part of this project. An information system was also designed and developed to manage the management contracts over the web, controlling and analyzing the production and the expenses according to the type of contract and the services provider. Thanks to the implantation of this system, all the information for the management of the contracts is centralized, accessible from anywhere over the internet and it offers the municipal government many facilities for the qualitative evaluation of the institutions that provide health services within
Technical and operational support for the implantation of new models for contracting health services
the areas of primary care, specialized care, hospital care and the provision of medical imaging services. Finally, this project has been revised and adapted to the manual of routines and work processes of the technical, economic-financial and legal team directly involved in monitoring the contracts.
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New Brazil office introduces sustainability criteria At the end of 2010 Gesaworld do Brasil opened new offices in the city of S達o Paulo. The growth of the company in the South American country has made it necessary to move to larger offices. The new installations, situated on Avenida Paulista underwent a series of reforms to adapt the space to the working needs of the company following sustainability criteria. The materials used are more eco-friendly and contain recycled materials, and the efficiency of the building has also been improved. An example of one of the measures taken is the installation of low-energy lighting, which can save up to 80% of energy while generating a lower thermal load on the premises, thereby allowing energy savings in air conditioning. Sensors that detect the presence of people were installed in the closed spaces and these bring even greater savings by turning off the lights when the space is unoccupied. Water saving systems were also installed and the floor was covered with a carpet that is easier to clean and which reduces the consumption of water for its upkeep. A coating made with mineral fiber
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and 40% of low-emission, recycled material with a low formaldehyde and VOC (Volatile Organic Compounds) content was used on the walls. This coating increases the quantity of light reflected in the interior and follows the criteria established by the LEED certification (Leadership in Energy & Environmental Design) for sustainable buildings. On the other hand, the fixed divisions of the office are of an all aluminum structure, a material that can be recycled countless times. The acoustic insulation is made from recycled PET containers or from basalt rock (the most abundant mineral in the entire world) and the movable divisions are made from FSC-certified (Forest Stewardship Council)wooden panels, which ensures the correct management of forests. The structure of the movable divisions is also made from aluminum, with 15% coming from recycled materials.
The Group consolidates its position on the Iberian peninsula Gesaworld opened new offices in Madrid in the middle of 2010, thus strengthening its process of expansion in the international arena.
The reason for opening this new office, the eighth offices of the company, is to articulate Gesaworldâ€™s business in Spain and Portugal, offering support to the corporate headquarters in Barcelona, which opened more than eleven years ago. The new offices in the Spanish capital will spearhead the activities on the Iberian peninsula, which play a key role in the development of the strategic plan of the group.
Opinion studies of users and professionals of the Portuguese social and health network Within the framework of the project for offering advice to the Unit Mission for Integrated Continuous Care, Gesaworld has developed activities in Portugal to support the knowledge, monitoring and continuous improvement of the recent National Network for Integrated Continuous Care(RNCCI) created in 2006.
In this respect, and with the aim of helping those in charge of this Network to typify and understand the situation of the perspective of users and professionals, Gesaworld carried out two national telephone surveys, which were directed at the patients of the RNCCI, and an on-line survey of all the teams that provide ongoing home care (permanent home care) in the country. The third survey, which was done by telephone, was directed at patients who were attended to in the admission units of the RNCCI, and its aim was to define their situation and history after they had been released from the RNCCI, through their level of use of health and/or social resources, their state of health and social situation compared to the situation at the time they were released or the level of satisfaction with the monitoring they received after they had been released from the admissions unit of the RNCCI.
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First São Paulo International Seminar on Primary Health Care Gesaworld’s extensive experience within the field of health management and the numerous projects that it has developed in Brazil have led it to organize the First International São Paulo Seminar on Primary Health Care. The First São Paulo International Seminar on Primary Health Care took place on 8-9 April. Under the title “Consolidating the efficiency of the system and the quality of the care”, the main objective of this meeting was to exchange national and international experiences of care models that have been successfully developed and facilitate an analysis of the initiatives of professionals from São Paulo and Brazil who are looking to provide new ideas and work processes. The act had special relevance because healthcare coordination and the integration of the services currently constitute a fundamental strategy to promote the processes of integrated health care in terms of the quality of the care, the arran-
38 | Gesaworld Annual Report 2010
gement of the services offered and the management of resources. To achieve this, Gesaworld brought together, for the first time, all the actors involved in attending the health needs of the population of the state of São Paulo (politicians, scientists, technicians, social workers, managers, etc.), and who have tried to look for solutions and find the best way to carry these out. The First São Paulo International Seminar on Primary Health Care was attended by a large number of specialists as well as the Mayor of the City, Gilberto Kassab, the Municipal Health Secretary for São Paulo, Januário Montone, and representatives from the Brazilian Ministry of Health and the President of the Gesaworld Group, Joan Castillejo, who participated in the round table on ‘Trends and challenges of primary health care ’. Another highlight was the speech given by the American Barbara Starfield, a lecturer and director of the Center for Primary Health Care Policies at Johns Hopkins University in the USA and regarded as an international authority on primary health care.
The recently deceased Barbara Starfield, during her speech to the Seminar
Handing over of the virtual recreation of the future Dr. Dávila Bolaños Military Hospital The project to replace the Dr. Alejandro Dávila Bolaños Military Hospital in Managua is already a virtual reality. The video recreating a trip a through the installations of what will be future hospital was handed over on 8 February. Gesaworld, in a consortium with the Pinearq architecture firm in Barcelona, was responsible for the functional and architectural planning of the project to replace the old center, through an exhaustive analysis of the needs of the population and of the offer and volume of activity of the current hospital. The new center, which introduces substantial improvements that will serve to guarantee efficient care in line with the health requirements of the locality, will have a total of 315 hospital beds, making it the main health infrastructure in the country. The hospital will also have the latest technology and a wide variety of medical specialties. The handing over took place in the meeting room of the General Management of the Hospital and those in attendance included Brigadier General Rene Darce, Head of the Military Medical Corps and Director General of the Hospital; the Teaching Sub-director, Joaquín Solís Piura; Major Gustavo Garcia; the architect Andrés Gutiérrez; the engineer Manuel Machado from the Technical Unit of the Project; and Deyanira Arguello of the Central American Bank for Economic Integration (CABEI), the entity charged with financing the project. Gesaworld was represented by Roser Vicente, Josep Lázaro, Edmundo Quintanilla and Azucena Saballos.
The video can be viewed through the following link
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Gesaworld, founding member of the Panama Green Building Council The Panama GBC is a representation of the World Green Building Council (WGBC), an international organization dedicated to promoting the sustainability of the Environment, and it has its offices in the United States. The WGBC is represented in more than 66 countries and its mission is to transform traditional practices of urban development towards sustainability as a condition, in such a way that the environment can be protected, economies can prosper and societies can grow, thereby ensuring the future health of the planet. The mission of the Panama GBC is to lead the evolution of the sustainable development of Central America and the Caribbean, with actions directed at all fields of social and economic development of the countries. At the present time, more than 16 companies and organizations form part of the Pa-
40 | Gesaworld Annual Report 2010
namรก GBC. These include LG, 3M, Johnson Controls, Construction Management Group, CB RICHARD ELLIS, RIPARD and Ciudad del Saber. The Gesaworld Group is a founding member of the Council in Panama and the Central America and Caribbean Region, whose aim is to lead and promote sustainable development from the perspective of the health and social sectors, which represent areas in the region in which the Group has accumulated vast working experience and which can boost the development of other social and economic sectors.
Design of an on-line course on improvements in quality management in Colombia The course grew out of the results obtained from the “Knowledge Management” or “Gestión del Conocimiento” project. The main objective of the “Knowledge management” project was the development of a systematic process of analysis and revision of international best practices in matters related to support strategies and methodologies to improve the quality of health services, mainly in hospitals. This process led to the selection, design and adaptation of more innovative methodologies and instruments and a greater level of suitability and adaptation to the reality of the Colombian health system. The project is part of the Program for the Reorganization, Redesign and Modernization of the Networks for the Provision of Health Services, financed by the BID and executed by the Colombian Ministry for Social Protection. As a result of this project, Gesaworld developed an updated inventory of best practices in matters of health quality, which represented the search and revision of more than 1,500 materials, scientific studies and articles related to a total of 15 thematic lines of investiga-
tion linked to aspects to improve the quality in hospital services. After that, the 20 instruments and methodologies which represented the international best practices were selected and these were adapted to the needs of the Institutions Providing Health Services (IPS) in Colombia. The instruments and methodologies were transformed into 20 tutorials for the self-learning of the health professionals of the IPS de Colombia, aimed at improving quality in 15 different thematic areas, related, among others, to the promotion and culture of patient safety, information systems for health and quality, organizational change, benchmarking and evaluation of health technologies. The tutorials led to an intense process of revision and validation in which more than 200 professionals from more than 15 health establishments in the country(IPS)participated. These tutorials and their learning materials were adapted to a web platform, linked to the web site of the Quality Observatory of the Colombian Ministry for Social Protection, which was accessible for the benefit of the entire Network of Institutions Providing Health Services in Colombia, consisting of more than 900 hospital centers.
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Gesaworld participates in the Sixth National Congress on Social and Health Care Sixth National Congress on Social and Health Care held at the end of May on the Viriato Campus of the University of Zamora. During the three days of the congress, the symposia and round tables offered a meeting platform for about 500 guests, mainly politicians and health professionals. A debate was held during the meeting about which social and health model was the most suitable for the Spanish situation and, in this respect the discussions focused on the best way to offer a more dignified life to older and dependent people through social and health services. Gesaworld participated in several of the organi-
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zed activities, such as the Symposium on “Social and Health Management”, which was moderated by Maria Luisa Lara, Director of Gesaworld in Spain and Portugal. The speakers who participated in this symposium were Inês Guerreiro, General Coordinator of the Portuguese Integrated Network for Continuous Care, Cristina Iniesta Blasco, Management Assistant at the Mar Health Park in Barcelona and Anton Mª Cervera Alemany, Director of the Geriatric Institute (IGER) at the Mar Health Park in Barcelona. The speakers at the symposium explained and debated the characteristics of the social and health care models developed in Catalonia and Portugal, as both represent successful experiences within the area of social and health care management.
Second international Seminar on regulation of the legislation and quality control of medicines in Central America Gesaworld organized this seminar, which took place in Panama on 22 and 23 June 2010. The Second Regional Seminar on the Harmonization of the Regulations for Quality Control of Medicines and Procedures for the Joint Negotiation of Prices continued on from the First Regional Seminar held in San Salvador in November of the previous year and it formed part of the Central American Protocol for Quality Control and the Acquisition of Medicines project which is being developed by the Inter-American Development Bank (IDB), the
Central American Social Integration Secretariat (SISCA) and the Central America Council of Health Ministers(COMISCA). The seminar supports the Central American Health Agenda 2009-2018, agreed by the COMISCA. The event was attended by more than 30 high level representatives from all the countries in the region, including representatives from the Public Health Systems of El Salvador, Honduras, Panama, Nicaragua and Costa Rica. Other international and cooperation organizations who work on similar themes in the region such as the OPS and the AECID and experts from Gesaworld also participated.
New trends in health management: executive training program This program is a response to the recycling or training needs of professionals in positions of responsibility within the health sector. Gesaworld organized and designed the executive training program â€œNew trends in healthâ€? in collaboration with the Department of Executive Training of the Faculty of Economic and Business Science of the Portuguese Catholic University.
The course, which was held between March and April, was directed at professionals from both the public and private health and social sectors who are responsible for the administration, planning and management of their organization and who are interested in bringing their knowledge of the sector up to date. They also received training in the leadership, strategy and management skills necessary to optimize and lead processes of change in their organization and within the health sector.
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Publication of the first book in the Temas para el Conocimiento y el Anรกlisis (Themes for Knowledge and Analysis) collection Gesaworld has published the first number of the collection in Spanish, entitled Evaluations of Health Policies and Programs. The Temas para el Conocimiento y el Anรกlisis collection, written, edited and published by the company was started with two fundamental objectives: to disseminate the methodologies and instruments that the firm uses in its work and to explain projects and experiences in detail. The books is given as a gift to clients and collaborators and Gesaworld hopes to complete the collection with further titles. Temas para el Conocimiento y el Anรกlisis sets out concepts, focuses and instruments that Gesaworld
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has used in its consulting activities. The publications will refer to specific projects that have been developed throughout the history of the company and which are examples of how to transform theoretical frameworks and instruments into elements for analysis and to improve the reality. The books aims to make a contribution to the debate and to discuss the major conceptual challenges of evaluation in health policies and programs and how these have been adapted to real contexts. The first title in the collection, Evaluations of Health Policies and Programs, will be of great use in helping to formulate the most important questions related to health policies and programs as well as for seeking and finding rigorous answers.
Workshop for the implementation of the EFQM model at Faro Hospital Faro Hospital and Gesaworld organized a workshop “Un Camino a la Calidad” (A Way to Quality), which was held on 16 July as part of the project to implement the model of excellence of the European Foundation for Quality Management (EFQM). The EFQM model is a holistic model of the certification that can be adapted to any type of organization. Gesaworld had the task of advising how to personalize this model and adapt it to the management reality of Faro Hospital, in accordance with the lines outlined in its strategic plan of quality. The aim of the workshop was to present hospital
professionals with the current situation of the certification project– fundamental objectives, methodology, critical points, next steps – and exchange the experiences acquired in the implementation of the EFQM model within the hospital area, at an international level and at the level of Faro Hospital. Many renowned experts on the subject participated in the session and these included Francisco Serra, a member of the Executive Council of the Board of Faro Hospital, Ernest Sarrias of Gesaworld, Francesc Cots, Head of Quality at the Hospital del Mar in Barcelona, Mónica Ballester, Head of Quality at the Germans Trias i Pujol University Hospital and the Head of Quality at Viladecans Hospital, José Campuzano.
Signing of a collaboration agreement with the Caribbean Coast University in Nicaraguan Gesaworld has signed an agreement with URACCAN for the interchange of experiences, knowledge and training projects in the social and health sector. Through this collaboration agreement, Gesaworld will contribute all its experience and knowledge on matters rela-
ted to the development of projects for consultancy, advice and technical assistance in the modernization and improvement of the health sector and social protection in the international arena. The main objective of the agreement is to develop joint initiatives for the design and start up of academic social development projects that contribute value added and improvements to Nicaraguan society. 45 | Gesaworld Annual Report 2010
Participation at the Third Primavera International Nursing Seminar The general theme of the Third Primavera International Nursing Seminar was “Transversality in Care”. The event was held at the Dos Hospitais Congress Center of the University of Coimbra in Coimbra, Portugal from 20-21 May. Montserrat Dolz, representing Gesaworld, was invited to participate as an expert in the round table entitled “Articulação interinstitucional para a qualidade dos cuidados. Evidência da acção dos enfermeiros”. Other participants included Pedro Pardal, representing the Mission for Primary Health Care, Inês Guerreiro, the Director of Mission for Integra-
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ted Continuous Care and Fátima Lima, Director of the Health Centers of Gouveia. Montserrat Dolz focused her speech on basic concepts and the main strategies developed on the articulation in the Catalan and Spanish public system, and she gave a description of the most relevant operational experiences.
Collaboration with SNOMED CT for the implantation of standard clinical terminology at a worldwide level Gesaworld has signed a collaboration agreement with the College of American Pathologists (CAP) to work together in Spain and the United States during an initial five-year period. The collaboration will be developed in relation to SNOMED CT (Systematized Nomenclature of Medicine), the standardized clinical terminology that helps health professionals with the recording, storage, analysis and exchange of information in a homogenous way. The agree-
ment will allow Gesaworld to provide the consultancy, training and implantation services associated with SNOMED CT in Spain and North America. This agreement consolidates Gesaworldâ€™s position in the international arena and it highlights its global nature and it will also helps position it as a leader and reference point in health standardization and interoperability at an international level. The SNOMED CT system is currently used in more than 50 countries around the world and it is also used by several organizations related to the standardization to promote the homogeneous use of clinical terminology.
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EC.1 Valor economico directo generado y distribuido Indicators of economic, environmental and social performance
Indicators of economic performance EC1 Direct economic value generated and distributed, including income, operating costs, retribution to employees, donations and other community investments, undistributed profits and payments to providers of capital and governments
Indicators of environmental performance EN1 Materials used
187 units of toner 305,000 sheets of paper 1,504.05 kg of paper
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(gross margin plus net gains on derecognized assets)
Gross margin Net Result of discontinued operations
3,812,047.49 € 0.00 €
Gains on derecognized assets not classified as non-current assets held for sale Gains on derecognized assets not classified as discontinued operations Economic value distributed Dividends Other administration expenses Personnel expenses Corporation tax and duties (1) RSC Investment amount
2,666,631.50 € 0.00 € 449,575.18 € 806,227.47 € 1,168,478.44 242,350.41 €
Economic value retained (Generated economic value less distributed economic value)
EN3 Direct consumption of energy
0.00 € 0.00 €
EN29 Environmental impacts of transport
45.31% of the trips made within Spain were by train
In 2010 a total of 2,016,790 km were traveled by plane
(1) This includes solely the expenses for Corporation tax and duties entered into the accounts during the financial year
Direct economic value generated
The international nature of Gesaworld means that professionals have to travel to the different offices of the company and to the countries where projects are being developed. These trips are unavoidable, however, the company is doing its best to reduce the volume of these trips and it has vouched for better organization, the use of videoconferencing and the hiring of local highly qualified executives.
Indicators of economic, environmental and social performance 5.3
Indicators of social performance Breakdown of collective of workers Age group
27.63 % 41 %
Area of studies 45 %
27 % 28 %
18 % 14 %
21 - 30
31 - 40
41 - 50
9% Male Hombre
non-University studies Estudios no universitarios
Health de Sciences Health Sciences Ciencias la salud Ciencias Sociales
Composition of the governing bodies Age group
40 % 32 %
35.71 % 28.57 %
Area of studies 45 %
27 % 18 %
31 - 40
41 - 50
7.14 % Ciencias la salud Health de Sciences
Ciencias Sociales Health Sciences
49 | Gesaworld Annual Report 2010
·· Administraçao Regional de Saúde do Algarve ·· Agence des services de santé et de services sociaux de Montréal ·· Agència de Protecció de la Salut ·· AGFA ·· Asociación Internacional de Fomento (AIF) ·· Associação Congregação de Santa Catarina ·· Autarquia Hospitalar Municipal de São Paulo(AHM)
·· Banco Centroamericano de Integración Económica (BCIE) ·· Banco Interamericano de Desarrollo (BID) ·· Banco Internacional de Reconstrucción y Fomento (BIRF) ·· Banco Mundial (BM) ·· BIO Eusko Fundazioa – Fundación Vasca de Innovación e Investigación Sanitarias
·· Cámara Navarra de Comercio e Industria. ·· Casa de Saude Santa Marcelina ·· Cámara de Comercio de Nicaragua (CACONIC) ·· Centro de Estudios Augusto Leopoldo Ayrosa Galvao ·· Centro de Estudos e Pesquisas “Dr. Joã Amorim“ (CEJAM) ·· Centro Hospitalario do Barlavento Algarvio (EPE) ·· CETIR, Grup Mèdic ·· Clínica Londres ·· Clínica Universitaria de Navarra ·· Confederação das Misericórdias do Brasil (CMB) ·· Consejo Superior de la Empresa Privada (COSEP) ·· Consorci Parc de Salut Mar ·· Consorci Sanitari Terrassa
50 | Gesaworld Annual Report 2010
·· Coordinación General de Planeación Estratégica (Subsecretaría de Innovación y Calidad) ·· Corporació Sanitària Parc Taulí
·· Departament d’Acció Social i Ciutadania (Generalitat de Catalunya) ·· Departament d’Innovació, Universitats i Empresa (Generalitat de Catalunya) ·· Departament de Salut (Generalitat de Catalunya) ·· Direcção Geral das Instalaçoes e Equipamentos da Saúde ·· Dirección de Organización y Calidad ·· Direction générale de la santé ·· ESADE
·· Fondo Financiero de Proyectos de Desarrollo de Colombia (Fonade) ·· Fundaçao Belho Horizonte ·· Fundação Hilda Arantes ·· Fundaçao Mario Penna ·· Fundación Hospital Asilo de Granollers (FHAG) ·· Fundació Clínic per a la Recerca Biomèdica (FCRB) ·· Fundació Hospital Santa Creu i Sant Pau ·· Fundació Privada Hospital de Mollet ·· General de Pirajussara ·· Gobierno Regional de la Región Autónoma del Atlántico Norte GRAAN. ·· Gouverment du Québec
·· ·· ·· ·· ·· ··
Hospital Albert Einstein Hospital das Clinicas Luzia de Pinho Melo Hospital de Nossa Senhora das Graças Hospital de Santa Caterina Hospital Santo Tomas (Ciudad de Panamá) Hospital Distrital de Faro
·· ·· ·· ·· ··
Hospital Estadual Américo Brasiliense Hospital Estadual de Bauru Hospital Estadual de Diadema Hospital Estadual do Grajaú Hospital Estadual João Paulo II (São José Rio Preto) ·· Hospital Estadual Manoel de Abreu ·· Hospital Estadual de Santo André (Mario Covas - FABC) ·· Hospital Estadual de Sapopemba ·· Hospital Estadual de Vila Alpina ·· Hospital Estadual Mario Covas (Fabc) ·· Hospital Geral Carapicuiba ·· Hospital General de Catalunya (Capio) ·· Hospital Geral de Guarulhos ·· Hospital Geral de Itaquaquecetuba ·· Hospital General de Itapecerica da Serra ·· Hospital General de Itapevi ·· Hospital Geral de Pedreira ·· Hospital Geral de Pirajussara ·· Hospital Geral de Vila Alpina ·· Hospital General do Grajaú ·· Hospital Geral Santa de Itaim Paulista ·· Hospital General Santa Marcelina do Itaim Paulista ·· Hospital Geral de Itapecerica da Serra ·· Hospital Integrado San Miguel Arcángel ·· Hospital Militar Dr. Dávila Bolaños ·· Hospital Prof. Carlos da Silva Lacaz (Francisco Morato) ·· Hospital Regional de Cotia ·· Hospital Regional de Pedreira ·· Hospital Regional de Porto Primavera ·· Hospital Regional Vale do Paraíba ·· Hospital Residencia Sant Camil ·· Hospital Santa Casa Misericórdia de Sobral ·· Hospital Santa Marcelina Itaquera ·· Hospital Universitario 12 de Octubre
·· ·· ·· ··
INDRA Innovamed Insitituto de Segurança Social Institut Català de la Salut
·· Institut Municipal d’Assistència Sanitària de Barcelona (IMAS) ·· Institut Universitari Dexeus ·· Instituto Frenopático de Barcelona ·· Instituto Hondureño de Seguridad Social ·· Instituto Interamericano para el Desarrollo Social (INDES) ·· Instituto Mexicano de Seguridad Social ·· Instituto Nicaragüense de Seguridad Social
·· Ministère de la Santé et des Solidarités ·· Ministério da Saúde de Portugal ·· Ministerio de Fomento, Industria y Comercio (MIFIC) de Nicaragua ·· Ministerio de Hacienda y Crédito Público (MHCP) ·· Ministerio de Salud de Chile ·· Ministerio de Salud de Nicaragua ·· Ministerio de Salud de Panamá ·· Ministerio de Salud Pública y Asistencia Social de El Salvador ·· Ministerio de Salud y Bienestar Social de Paraguay ·· Ministério do Desenvolvimento Social e Combate à Fome ·· MODERNA ·· Naciones Unidas (ONU)
·· Parcerias (Saúde) ·· Prefeitura de Londrina ·· Programa de Naciones Unidas para el Desarrollo (PNUD) ·· PRODAM – Empresa de Processamento de Dados do Municipio de São Paulo ·· Prontocárdio-pronto atendimiento cardiológico s/c ltd.
·· Quinta de Salut L’Aliança (MPS) ·· REFORSUS
·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ··
Secretaria da Saúde do Estado da Bahía Secretaria da Saúde do Estado do Ceará Secretaria de Estado da Saúde de São Paulo Secretaría de Estado de Salud de Chihuahua Secretaría Ejecutiva del Sistema Nacional de Prevención, Mitigación y Respuesta a Desastres Naturales SE SINAPRED Servicio de Salud de Veracruz Secretaría de Estado de Salud de Guanajuato Secretaría de Salud de la República de Honduras Secretaría de Salud de México Secretaría del Estado de Salud de Chiapas Secretaria Municipal de Saúde de São Paulo Servei Català de la Salut Servicio de Salud de Zacatecas Servicio Extremeño de Salud SIEMENS S.A. Sistema de la Integración Centroamericana (SICA) Sistema d’Emergències Mèdiques (SEM) Subdirección General de Servicios Sanitarios.Departamento de Salud, Generalitat de Catalunya
·· UDIAT, Centre Diagnòstic, S.A. ·· União das Misecordias Portuguesas ·· Unidad Coordinadora del Programa de Modernización del Ministerio de Salud ·· Unidade de Missão para os Cuidados Continuados Integrados (UMCCI) ·· Unió Catalana d’Hospitals (UCH) ·· Unión Europea (UE) ·· Universidad Estadual de Río de Janeiro ·· Universidad Federal de São Paulo
Index of GRI indicators
p.6 p.8 p.9
2. Profile of the organization 2.1 Name of the organization 2.2 Main brands, products and services 2.3 Operational structure of the organization, including the main
divisions, operational entities, subsidiaries and joint ventures
2.4 Localization of the main headquarters of the organization 2.5 Countries in which the organization operates and the countries in which
p.10 p.11 p.12 p.13
2.6 2.7 2.8 2.9
it carries out significant activities or which are specifically dealt with in the Annual Report with regard to the aspects of sustainability Nature of ownership and legal status Markets served Size of the organization Significant changes during the period covered by the Annual Report
3 3.1 3.2 3.3 3.4
Report Parameters Period covered by the information contained in the Annual Report Date of the most recent previous Annual Report Cycle of presentation of Reports Point of contact for matters related to the Annual Report or to its content
4 Management, commitments and strategic lines 4.1 Governing structure of the organization p.15 4.13 Main associations to which Gesaworld belongs p.14
5.1 Indicators of economic performance 5.2 Indicators of environmental performance p.49 5.3 Indicators of social performance p.48
51 | Gesaworld Annual Report 2010
Gesaworld, S.A. C/ Comte d’Urgell 204, 5º B 08036 – Barcelona – España T. +34 93 363 03 27 Gesaworld DO BRASIL LTDA. Avenida Paulista, 1499 Cjs 1106/07/08/09 01311-928 São Paulo. Brasil. T. +55 11 3371-3111 Gesaworld CHILE, LTDA. Oficina 404 C/ Padre Mariano 181 Providencia Santiago de Chile. Chile T . +56 2 3621504 Gesaworld MADRID C/ Génova 15, 3º Ext. Derecha 28004 Madrid. España T. + 34 91 308 22 25 Gesaworld MÉXICO, S.A. de CV Gob. Francisco Fagoaga No 80 Col. San Miguel Chapultepec 11850 México D.F. México T. +52 55 5276 5050 Gesaworld NICARAGUA Gesaworld S.A. Oficina en Nicaragua Edificio Málaga, planta baja, Módulo A-14. Managua. Nicaragua T. +505 266 4314 Gesaworld PANAMÁ, S.A. Calle 52 y Elvira Mendez Edif. Vallarino, Piso 5 Of. A Zona Bancaria Ciudad de Panamá Panamá T. +507 209 5241 Gesaworld PORTUGAL LDA. Rua de S. Nicolau, No 121, 4º andar 1100-548 Lisboa. Portugal T. +351 21 88 79 220 Gesaworld USA L.L.C 1625 I Street NW, Suite 620 Washington, D.C. 20006 (EUA) T. +1 202 429 20 45