"We have hired 1,200 workers, which has made it possible to improve service to standard ratios"

The Hospital Universitario de Canarias has undergone a transformation with the arrival of the new Managing Director, María Mercedes Cueto, with extensive experience of more than 20 years in the management of these types of areas and health complexes. The coronavirus pandemic has meant adapting and creating new infrastructures, implementing new criteria and formulas for work and patient care.

-How is the situation of the center in the pandemic? What evolution has the patient you attend to?
“The HUC is much better than last year. In the first wave we had a lot of admissions from older people and now we have more young people, but they are more admissions in the ICU and serious. The wave does not end to subside and we maintain a high incidence of positive diagnostic tests. We have 10 beds occupied in the 24-seater ICU, a high percentage, and we have another 24 beds to expand in spaces such as recovery (REA), emergencies, coronaries …, a dynamic data taking into account non-COVID critical patients. Now patients are not afraid to leave their homes and come to the emergency room. If in the first wave we had 50 or 70 patients a day, now we have about 200 daily emergencies, and we attend to people with more chronic complications ”.

-What has this pandemic meant for the Center?
“During the pandemic, we have seen the great professionals we have, who have been extremely flexible to adapt to the new way of working, new circuits, new schedules, dubbing, using personal protective equipment, training… It has meant making the way of working more flexible and the entire center works with two circuits, one for COVID patients and the other non-COVID. We have also adapted the infrastructures to the current situation, and we have implemented new formulas for patient care. We have made more than 154,000 telephone inquiries in 2020, in addition to attending 500,000 users in person. In addition, we made about 75,000 inter-consultations between our professionals and those in Primary Care. This learning process has been good for us to move forward, not settling in the usual comfort has been done that way, and it has made us be more imaginative and change procedures. We have formed COVID teams made up of different specialties and there were times when we asked for volunteers from other services to care for COVID patients and we saw the generosity of other specialists who offered to assist them ”.

-How is the health of the staff currently?
“There is a very important advance after vaccination. If last year we had some 154 infections on a workforce of 4,425 workers, now we have more than 90% of immunized personnel and that provides security, although we cannot lower the protection measures. The few cases that we are having are people who have not been vaccinated or have been infected through family and social contacts, not in-hospital. Now we do not have problems with PPE when in the first wave we experienced a lot of anguish because we did not know if we would have gloves, masks or divers. There is great fatigue in the staff, there are many months in tension due to the pandemic ”.

-What investments have you had to carry out in the hospital?
“The pandemic has involved a very important investment in economic resources, the Ministry and the SCS have been very sensitive to this issue and in equipment and reagents we have spent more than 7 million euros in the HUC alone. We have carried out emergency works at a cost of 3,319,135 euros to expand hospitalization by 86 new beds, 42 beds in December (Body M) to expand the Emergency Service, and another 44 beds in March (Body D) to deal with to COVID, but they will be multipurpose in the future for other areas. We have also made changes to guarantee assistance in the surgical area and sterilization. We have made an investment in material and equipment of almost 500,000 euros, especially in sterilization, which is an essential service for the proper functioning of the operating room and to avoid the risk of complications, buying instrument washing trolleys, three trolley washes or two sterilizers new. We have also increased the staff in this area because it was very tight, and thus we can improve the speed of sterilization. In the operating rooms we have renovated four surgical tables, 11 new lamps and towers that allow laparoscopic, arthroscopic and mediastinoscopic interventions ”.

-What other steps have you taken to improve its use?
“We have appointed a medical coordinator who is in charge of optimizing the operation of the operating rooms, reducing downtime and minimizing operation suspensions. We have also increased the nursing staff on duty and now we have two nurses and two assistants which has allowed us to increase operations. These advances have allowed us to increase scheduled surgical activity by 15% and we have an operating room occupancy of 77.7%, a good indicator. We have also increased the pediatric surgery service, with two more surgeons, which has also allowed us to collaborate with La Candelaria so that our surgeons go down one day to operate there and spend a day consulting at the Hospital de Ofra. We attend pediatric emergency events. We are promoting home hospitalization with 11 more beds and we have reached 30 places ”.

-Has the lack of personnel in the HUC been chronic for years?
“Yes, and in the pandemic we have incorporated almost 1,200 more workers, so we are 5,600 on the December payroll. The growth of personnel has allowed us to adapt to working in the standard ratios, we have increased the ICU staff, especially nursing and auxiliary, to work in a ratio of care to COVID patients of one nurse or one and a half for two beds at most, it depends on gravity ”.

-Is the HUC the center with the largest number of workers with contracts that are renewed year after year, almost a thousand (762 health professionals and 213 management and services), who should be regularized at least to interns?
“It is a problem that the entire Canarian Health Service has, but it is true that the temporality that we have in the HUC is a little higher than in other centers. For example, more than 70% of doctors are staff with temporary contracts that are renewed year after year, and that makes them have a certain instability and insecurity about their future. The SCS director and the counselor himself are very concerned and I think it will be solved soon. With the hires made in 2020 and 2021, we have become very close to the ratios that we have on average in other hospitals in the Canary Islands. But the HUC has the peculiarity that the cleaning, maintenance or laundry personnel, to give three examples, is their own and is a great value while in others they are outsourced services. There are ratios, as in nursing, in which we are below other hospitals, but we have hired nurses and auxiliaries for the hospitalization floors to guarantee that the care is in accordance with quality standards. Regarding the eventuality, this direction has put a lot of effort into stabilizing our staff, and in 2020 we have made 350 interim contracts of statutory staff, we have resolved the OPE convened in 2007, and 431 nurses and aides on permanent staff have taken possession . We have made an effort so that the new temporary contracts are not short, but for a period of one year when the position is structural and needs to be covered, to give greater stability to the workforce. The human resources website that facilitates all the procedures, has had more than 13,000 visits, and we have launched a Telegram channel to inform about the job lists. We have made 116 calls for employment, of which 85 have been resolved ”.

-Is the HUC still the benchmark in different areas?
“We are very proud to be pioneers in robotic surgery with Da Vinci, and its use has been consolidated in services such as urology, general surgery, gynecology and we have been pioneers in operating on bladder cancers. It is a more precise surgery and has fewer risks. This year it will be used in thoracic surgery and in the intervention of cancers found in areas of difficult access. We are also a reference in the province in cardiac surgery, a service that in 2020 performed 7,777 open heart surgeries. We are also very proud to have performed more than 3,030 kidney transplants and to be a reference for pancreatic renovations, about 120, with the encouragement of doctors Antonio Alarcó and Armando Torres ”.

-What advances are being made in Major Ambulatory Surgery that allows reducing the waiting lists of patients?
“It is very important, since it allows the patient to enter and that on the same day or the next morning, he can return to his home. We have five operating rooms dedicated to this activity for operations of all kinds and two more specifically for ophthalmic surgery. This allows us to operate 28% more outpatients than the rest of the tertiary level hospitals, which can mean 1,500 more interventions per year. In 2021 we want to start the 24-hour CMA project, which will mean that this surgery will not close as now at 9:00 p.m., we will be able to operate more ”.

-The 50-year-old buildings need major renovations. When will they take place?
“The HUC has an obsolete infrastructure in the areas of hospitalization, emergencies, operating rooms in the central block and laboratories. It is clear that a total renovation of the hospital building must be undertaken due to its age. It is difficult to live health care with a work, but you have to assess the benefit of being able to have something soon. Patients and professionals cannot afford to wait many more years and need renewal in the short term ”.

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