University of São Paulo, Brazil - A JBI Endorsed Hospital
In 2019, JBI granted the Nursing Department of University of São Paulo Hospital JBI Endorsed status to recognise its commitment to evidence-based healthcare practices, continuous quality improvement, and ongoing professional development for clinical staff. The journey to achieve this award has been incredibly rewarding and improved the way healthcare staff think about and administer patient care.
The University Hospital of the University of São Paulo (HU-USP) is a state-owned public teaching hospital located in the western region of São Paulo, Brazil. The hospital, which serves the University of São Paulo community and the consumers of the National Health System (Sistema Único de Saúde – SUS), has 147 active beds distributed among medical, surgical, paediatrics and obstetrics areas.
The HU-USP’s Nursing Department, in partnership with the School of Nursing at the University of São Paulo, established the Nucleus of Evidence-Based Nursing (NUEBE) in 2013. The aim of the NUEBE was to create and embed a culture of evidence-based practice. To this end, members of the NUEBE received training from the Brazilian Centre for Evidence-based Healthcare (a JBI Collaborating Entity) to equip themselves with the skills needed to implement evidence into clinical practice.
Trained members of NUEBE identified key clinical areas for improvement, which included maternal care (e.g., prevention and management of primary postpartum haemorrhage, prevention of nipple trauma among breastfeeding mothers), and prevention of catheter-related bloodstream infection and falls. Along with their teams, they then conducted implementation projects aimed at decreasing the incidence of infection, falls and maternal complications. From the success of these initial projects, which were later rolled out to the relevant sections of HU-USP, more and more nursing staff in the hospital attended the training and were given the opportunity to work on other key priority areas of the hospital.
The strong collaboration between the hospital and the university, and the capacity building efforts of the NUEBE laid the foundation for continuous quality improvement in the hospital, creating a culture of innovation, evidence-based practice, and excellence in healthcare.
‘Many of the clinical areas identified by trainees (nursing staff) to be the focus of their evidence implementation programs have been difficult, but we felt so rewarded and proud along the way. The communication lines have been more open, reporting and documentation has significantly improved, and staff have never felt so confident in challenging their managers and those in leadership roles to examine and evaluate areas that are not doing so well.’ Karina Sichieri--- JBI Evidence Implementation Trainer Brazilian Centre for Evidence-based Healthcare: a JBI Centre of Excellence.
When the JBI Endorsement program was launched in 2018, the Nursing Department of HU-USP was able to demonstrate what structures and processes they had put in place to improve numerous areas of clinical practice. At the time of making the application for JBI Endorsement, the Nursing Department had integrated quality governance systems and well-coordinated teams working to improve processes in clinical areas such as intrapartum and newborn care, aged care, discharge planning post-surgery, and delirium in critical care settings. Continuous monitoring of progress through an adaptive, real-time feedback loop led to improved care transition from hospital to home following a surgical procedure, increased screening and assessment of delirium in the critical care setting, better education for postpartum mothers to facilitate breastfeeding, and the development and implementation of evidence-based protocols for pain management among postnatal mothers and newborn babies.
‘The sustainability of any change implemented can be a significant challenge, reiterating the need for a continuous cycle of clinical audits, as envisaged by the JBI evidence implementation model and facilitated through the JBI Endorsement program.’ Karina Sichieri--- JBI Evidence Implementation Trainer Brazilian Centre for Evidence-based Healthcare: a JBI Centre of Excellence.
Following the rigorous assessment performed by the JBI Endorsement Unit, the Nursing Department was granted a FULL ENDORSEMENT status, recognising their robust processes for quality improvement and capacity building. The JBI Endorsement unit recognised the leadership team was strong and committed to promoting a learning and supportive culture. Major strengths of the department included a compelling commitment from leaders and managers, an engaged workforce, and the strategic partnerships created with relevant teams and external groups. The JBI Endorsement unit highlighted opportunities for refinements in their quality improvement approach, including collaboration with other disciplines when identifying priority areas, to ensure that the quality indicators being tracked are meaningful and lead to the efficient and effective use of hospital resources.
Fast forward to 2022, the hospital conducts multidisciplinary, hospital-wide practice evaluation programs rather than limited to ward-or unit-based projects, with organised teams and change champions that pursue challenging but realistic targets and share the strategic vision of improved service delivery and health outcomes.
‘JBI Endorsement is not only a prestigious badge for our hospital, but it also provides a framework for us to regularly examine our practices and review our service outcomes to ensure we are delivering the best possible care to our patients and their families. It has also been a very important component of the partnerships that we have created over the years to achieve sustainable implementation targets. What we have achieved so far in the hospital would not have been possible without JBI Endorsement, as the support we continue to receive from the knowledgeable and experienced implementation methodologists is invaluable. They gave us a roadmap and empowered our healthcare staff to identify challenging issues and provided them with knowledge, skills and resources needed to implement solutions in an evidence-based way.’ Prof Vilanice Alves de Araújo Püschel, Director of the Brazilian Centre for Evidence-based Healthcare: a JBI Centre of Excellence.
The Nursing Department of the University of São Paulo Hospital is the first health facility in Brazil to achieve JBI endorsed status, an internationally recognised designation of excellence in health care. This highlights not only the exceptional dedication, hard work and perseverance of the healthcare staff, but also the generous and unparalleled support from JBI mentors, academics and research fellows who continuously share their implementation knowledge and experiences.
‘With JBI Endorsement, the University Hospital of São Paulo demonstrates its commitment to providing the best evidence-based care for our patients. The practice of continuous improvement of care quality through the construction of care protocols that are evidence-based, ensures we are implementing best practices. With this, we seek to increase the hospital's status and credibility as a quality healthcare organisation for patients, family members, professionals and students, and expand the hospital's visibility at a national and Latin American level.’ Karina Sichieri, Technical Head of the Clinical Nursing Division
The University of São Paulo, Brazil