Health Care Communitarianism in Colombia

by JHI Staff on June 23, 2014

FSFB

There is no one institutional path to becoming a provider of high-quality, safe, affordable health care. It’s not, for example, about private vs. public, or profit vs. non-profit. Rather, it’s about being mission-driven, structuring for sustainability, and building around local culture and needs. In our collaborations with health care providers, payers and government agencies around the world, we at Johns Hopkins Medicine International (JHI) have worked with different models for how care is paid for and delivered. We’ve seen that any model can succeed or struggle, depending on the context and implementation.

Actually, there’s one model we don’t often encounter in our global collaborations—the one we follow at Johns Hopkins Medicine. The model is that of the academic medical center, dedicated to providing not only top-notch care, but also medical education, and to advancing the state of medicine through research. Our model also involves a commitment to expanding the scope and accessibility of medicine everywhere through our work in public health and our efforts at JHI.

But one global collaborator of ours that follows much the same model is Fundación Santa Fe de Bogotá (FSFB), in Colombia. And, though much of what FSFB does is similar to what we do, the differences in regional context lead to some sharp contrasts.

For example, here in the U.S., Johns Hopkins Medicine is one of many fine academic medical centers. Though we strive to deliver the very best care to patients, we can’t claim that most patients who come here from Maryland, or from other parts of the U.S., don’t have several options for good medical care. But in the Bogotá region and to some extent in all of Colombia, FSFB is a unique institution, offering care and services that many in the region wouldn’t be able to get anywhere else. Unlike Johns Hopkins Medicine, FSFB can’t draw on the resources of a vast, longstanding, advanced medical infrastructure to grow and maintain its capabilities. Since its founding in 1972, FSFB has not merely reflected the progress of Colombia’s health sector; it has been instrumental in defining that progress.

Because JHI collaborates with FSFB, I’ve had the pleasure of getting to talk to that organization’s dynamic leader, Juan Pablo Uribe. I find it inspiring how seriously he and all the leadership of FSFB take the responsibility of advancing the state of medicine and health care in their region and country. Anyone who knows Dr. Uribe’s background would expect no less: A former World Bank senior manager focusing on health care, he held posts in Colombia as the vice minister of health and the national director of public health before taking the helm at FSFB.

For Dr. Uribe, FSFB’s role is more than just a health care mission: It’s a world view, one that he likes to refer to as “communitarianism.” That’s a term with some history in political and social movements and in philosophy, but the essence of what Dr. Uribe means by communitarianism is when local, private institutions become important not merely in providing useful services to the public, but in shaping the community.

That drive to impact the community in ways that do the most good is clear in many of FSFB’s efforts. It established a Community Health division that focuses on improving environmental health factors in Bogatá’s most vulnerable communities through education, training, social mobilization, direct intervention and policy. It established the Center for Studies and Health Research to advance medicine’s understanding of and ability to control infectious and other diseases that are a particular burden to the region, including malaria and dengue. It has helped design and implement systems for monitoring health outcomes for Colombia, and has been a pioneer in applying health economics and technology to bettering health care delivery. It has been continuously involved in forming local and national health policy, including the design of comprehensive health care plans.

Of course, FSFB’s commitment to improving health among those who most need it is best exemplified by the care it directly delivers. Its University Hospital was the first Bogotá-region hospital to receive Joint Commission International accreditation, and the second in Colombia.

FSFB has been at or near the forefront of virtually every one of the country’s medical advances for three decades, performing the first liver and cardiac transplants there, providing start-of-the-art imaging, radiosurgery and neonatal care capabilities, and establishing Colombia’s first emergency clinic and one of its first intensive care units. Its institutes of oncology and cardiovascular disease are at the tops of their fields. And it has been a leader in the country in emphasizing the importance of advanced nursing practices to good health care outcomes.

Meanwhile, FSFB’s faculty has generated more published medical research than any other institution in the country, much of it in collaboration with counterparts elsewhere in Latin America and in the Caribbean.

All of JHI’s collaborations are two-way streets, enabling us at Johns Hopkins Medicine to not only share our expertise but also learn about medicine in different cultural and health contexts. In the case of FSFB, the collaboration has inspired us to reflect on our mission—and remind ourselves that no matter how much we do to improve health and advance the field of medicine, there is so much more to be done.

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John Griswold July 10, 2014 at 3:56 pm

I would concur that rigorous discussion is needed to fine tune cultural models and the implementation work never assumed to be complete. This ongoing effort is the objective in the final element of the work management process (to include clinical, nonclinical and plant) called variance analysis and continuous improvement. I sense that somehow the status quo thinking is that productivity improvement and cost reduction efforts work against the mission objectives when in fact they are critical parts to achieve it. I can think of one effort where productivity of the work was improved by the local professionals, excessive costs were recovered, wages were competitively raised and turnover substantially reduced to improve patient care. For certain more work needs to be done to realize these potentials and continue to evolve these cultural models for improving these morale, social and business objectives.

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