Identificação dos impactos da relação entre a gestão da qualidade e a integração sobre a eficiência de organizações de saúde – Um estudo de casos múltiplos

Abstract

Efficiency in healthcare organizations consists in the ability to produce a specific output with the least amount or quantity of waste, expense, or unnecessary effort of the professionals involved, which implies the integration of these professionals and their participation in quality management. Through a multiple case studies research, semi-structured interviews were applied with 32 professionals of three large health organizations. Therefore, three large hospitals located in Rio Grande do Sul State, Southern Brazil. The data analysis shows that integration occurs at the formal leadership level only in one of the organizations and does not involve the medical and operational professionals. Quality management seems not to be fully incorporated into care routines, which can be evidenced by the difficulty in making the professionals adhere to hand hygiene, because of the underreporting of errors and the rate of infections being higher than the goal established. It is suggested that the existing barriers to integration and the difficulty in incorporating good quality management practices are related to efficiency losses, reflected by the high average stay rate, poor utilization of rooms in the surgical block, lack of separation of clothes according to the degree of dirtiness, inability to manage the time needed for hygiene and bed release, lack of a discharge planning, and the need to create jobs to supervise the work performed by the sanitation in the three hospitals. Therefore, a framework is proposed as a theoretical contribution, suggesting that by implementing integration and quality management, when supported by the following interpersonal relationships: trust, communication, and leadership, efficiency is improved. Finally, some premises for future research were designed.