In an earlier post I expanded upon my fascination with Barretos Cancer Hospital’s many vehicles and their connection to this mission of reaching farther and farther across the map of Brazil. Entering the second week yet another attribute of this hospital has attracted my attention. Yes they are incredibly invested in the mobile unit program, expanding their radius of care; however they are doing so with a meticulous attention to the maintenance of quality across their growing branches. Many of the projects we have heard of are all around the issue of quality control. Doctors, nurses and administrators are all asking the question, “How?”. How can an institution standardize their quality of care regardless of how far it is traveling? Seems like a lot to take in and quite daunting to confront. These professionals do not stop here. The questions grow in scope, and the picture gets bigger. How can a single provider of health unite with its fellow institutions across the country to guarantee this quality for patients no matter where they are in the health care system? Before I stand, flabbergasted, looking at these huge issues, I take a step back and once again fall in love with the people and place asking these questions and striving for answers. It is one thing to have a vision and see it to fruition. It is another to keep dreaming, having those dreams grow, taking those steps forward and elegantly snowballing your original idea into this massive, ambitious force. That is my new favorite thing about Hospital de Cancer de Barretos (referred to here as “Pio XII”, the name of the foundation created with the hospital).
On our first visit to the children’s hospital, the medical director, Dr. Luis Fernando, mentioned holding themselves to the standards of St.Jude’s and top-tier cancer hospitals in Germany. He explained the focus on measuring their performance and analyzing shortcomings. These high standards are what propel HCB from the ranks of mere government-funded hospitals and into those with some of the best institutions in the world. It so happens that Nikhil and I have actually found ourselves a project within this realm of quality assurance. The hospital has about 30 mammography machines (and probably more that I was not able to catch in the middle of translating Portuguese to English). Some are at fixed locations and some are on wheels, distributing preventative cancer care to the various cities in the region. The Director of Mammography Clinical Quality Control, Dr. Silvia, is in charge of ensuring the mammograms are top notch regardless if they were taken in the back of a truck in small Viradouro or in the Prevention Department at headquarters. The quality control program they have in place tracks types of mistakes, and about 90% are due to technicians. Looking through 5% of images taken by each technician every day in real time,
Dr. Silvia is able to tell which mistakes are the most common. Each month she calls in the lowest performing technicians for training at HCB, bringing costs to the hospital. If there existed an online training program focused around these common and recurring mistakes in breast positioning, Dr. Silvia could send the training to the technician instead of the other way around. This is where we come in. Today we began uploading our course online where Dr. Silvia will review our work before sending it out to the first batch of technicians. Although it seemed out of our area of expertise, I see why recruiting two undergraduates who never thought about how to position breasts for mammograms may have been a good idea. With some initial material and Dr. Silvia’s reference textbook (conveniently in English) we were forced to make sense of everything in the simplest terms. Once we got it, teaching it proved to be quite simple. However thinking back to the big picture driving this hospital’s innovations and efforts, simple things have a knack of becoming quite extraordinary.