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Gestão da qualidade total num serviço de saúde

Authors: Henriques, Carlos José de Afonso;

Gestão da qualidade total num serviço de saúde

Abstract

A prestação dos serviços de saúde, pela particularidade do bem Saúde, determina características específicas para as organizações. A qualidade na saúde atende a essas particularidades. Neste estudo, através da metodologia de investigação-acção, implementámos um plano de melhoria a um Bloco Operatório Central tendo como ponto de partida o diagnóstico realizado com base no modelo de excelência europeu (EFQM). Com base em entrevistas semi-estruturadas aos chefes (enfermeiros e cirurgião) da unidade, consulta de documentos elaborados pelos responsáveis e dados do sistema de informação do hospital, foi elaborado um documento que descreve a realidade da unidade de estudo. Este foi avaliado pelo modelo de excelência europeu nos moldes de uma proposta pró-forma ao prémio de excelência. Este diagnóstico inicial orientou a elaboração de um primeiro plano de acção. Implementámos o plano e avaliámos o impacto nos resultados conseguidos na unidade de estudo. A implementação de um plano de melhoria baseado no modelo EFQM parece ter influenciado positivamente os resultados da unidade, quer em termos de doentes cancelados, quer no que respeita à utilização dos tempos operatórios. Este resultado foi conseguido com um acréscimo no número médio de doentes programados intervencionados. Concluímos assim, que a implementação de metodologias de melhoria contínua, com base no modelo EFQM, parece ser uma alternativa válida como estratégia de melhoria da qualidade nas organizações de saúde. Pensamos que para investigações futuras será útil desenvolver estudos que relacionem este modelo com outras unidades de saúde nacionais em vários serviços.

Health care organizations, because of the uniqueness of the good Health, determine specific characteristics to these organizations. Quality in health care is sensitive to these unique characteristics. In this study, trough an improvement action-plan, we put into practice action-research in an Operating-room setting, starting with a diagnostic study based on the European excellence model. Based on Interviews to the matron and the unit director, documents written by the unit’s leading team and data collected from the information systems were used to structure a document that described the unit’s reality. This document was then used as a pro-forma application to the excellence award to score the Operating-room setting. This initial diagnostic guided the development of a first action-plan. The plan was implemented and its impact on results evaluated. The development of a continuous improvement method based on the EFQM model appears to have influenced in a positive way the results in the studied unit. These results are seen both in terms of the number of cancelled surgeries, and in the usage rate of the Operating rooms. These results were achieved simultaneously with a higher number of programmed patients submitted to surgery We concluded that the continuous improvement methodologies, based on the EFQM model, seem to be a valid alternative as quality improvement strategy to health care organization. We propose for future studies that a similar approach could be applied relating the EFQM model with other national health care units in various settings.

Classificação JEL: I18, I19

Country
Portugal
Keywords

EFQM, Operating rooms, Action-research, Investigação-acção, Gestão da qualidade, Quality management, Bloco operatório

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selected citations
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This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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