Decisores hospitalares: necessidades formativas e informativas
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2004
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Segundo a ortodoxia contemporânea, são os mecanismos da concorrência que proporcionam o motor fundamental para o progresso económico e social. Assim sendo, não é de admirar que um conjunto de
forças levem, muitas vezes, à importação de modelos do sector privado para a gestão da administração pública, provocando, desta forma, alterações na malha das relações institucionais, sem que, ao mesmo tempo, se processe à adaptação e reforma internas. A maioria das propostas centram a sua atenção em medidas susceptíveis de produzir uma redução dos custos unitários, eliminando o desperdício e a ineficiência e de incrementar a qualidade do serviço prestado, avaliada na perspectiva da satisfação dos utentes. O impulso fundamental para esta constante melhoria da qualidade e redução de custos encontra-se na inovação.
Porém, sem incentivos (in)formativos que sirvam de apoio à inovação no sistema de saúde, as possíveis reduções de custos a curto prazo ver-se-ão superadas, rapidamente, pela crescente necessidade de uma prestação de serviços de saúde a uma população cada vez mais envelhecida e que não está disposta a conformar-se com um tratamento que não seja o melhor. Inevitavelmente, a falta de fomento à (in)formação dos profissionais da saúde dará lugar a uma menor qualidade na decisão ou a um maior racionamento (ou produzirá maior segregação) da assistência, sendo ambos igualmente indesejáveis.
Tomando por base toda esta conjuntura, estabelecemos como objectivo principal da presente investigação a realização de um ensaio sobre as principais componentes dos perfis dos decisores hospitalares, tendo por base os seus percursos formativos e as suas necessidades de informação. Para além deste objectivo último, procuramos igualmente conhecer os percursos pessoais e profissionais dos decisores hospitalares inquiridos e a (in)formação que foram angariando ao longo dos mesmos, bem como a percepção que detêm sobre o processo de tomada de decisão nas suas instituições.
Metodologicamente, começamos por desenvolver um suporte teórico que nos permitisse identificar e analisar os factores internos e externos que impulsionam e limitam os processos de tomada de decisão. De seguida, foram estabelecidos contactos, formais e informais, com informantes - chave do sector para que, conjuntamente com o referencial teórico criado, pudéssemos desenvolver o guião das entrevistas que realizamos aos cinquenta e três decisores hospitalares. Os dados assim obtidos foram posteriormente organizados de forma a serem tratados estatística e econométricamente nos softwares SPSS e STATA.
Os resultados obtidos, para além de nos darem a conhecer os percursos pessoais e profissionais dos decisores hospitalares inquiridos e as suas concepções sobre o processo de tomada de decisão nas suas instituições, mostram, ainda, que existem três perfis distintos no grupo de decisores hospitalares; os que fazem e procuram formação e informação apenas para o sector (saúde); os que fazem e procuram formação e informação apenas para a função de gestão que desempenham (decisão); e os que fazem e procuram formação e informação para o sector e para a função. A composição de cada um dos perfis permitiu-nos, simultaneamente, o apuramento das principais características que os distinguem.
According to current orthodoxy, it is competitive mechanisms that provide the fundamental motor of economic progress. This being the case, it is hardy surprising that a series of factors have become conducive to the not infrequent importation of models from private management the public administration. This transfer obviously has its effects on the pre-existing network of inter-institutional relationships without necessarily promoting the corresponding internal reforms and adaptations in the organisations involved. The majority of transfers of this sort aim ostensibly to reduce unit costs, eliminate waste and inefficiency, and improve the quality of services, always with the focus on “promoting customer satisfaction”. The main weapon used in this permanent assault on low quality and high costs is innovation. Yet without incentives to the improvement of both the training and information on which innovations n health delivery systems depend, short term cost reductions are likely to be exceeded by the costs of health care delivery to a population that is increasingly aged and unprepared to tolerate treatment the quality of which is in any way inferior. Inevitably, constraints on the training and information inputs into health professionals’ career development give rise to a series of undesirable outcomes, including reduced quality of decision-making, greater (and not necessarily equitable) rationing of resources, and/or more discriminatory distribution of health care inputs. With the above considerations in mind, the main aim of the present research was to identify the main components that determine the profile of the typical hospital decision-maker, based on an analysis of the training received over the years, and the corresponding informational needs. To this end, using interview and questionnaire techniques, an attempt was made to specify the career-long training pathways and the corresponding informational “requirements” and “acquisitions” of hospital decision-makers, along with their perceptions regarding hospital decision-making (in general) and the role of training and information in that process (in particular). In methodological terms, the study began with the identification – in theoretical terms – of the internal and external factors that contributed to and constrained decision-making. Subsequently, formal and informal contacts were established with key informants in the hospital sector, with a view not only to validating the initial a priori assumptions regarding the decision-making process, but also to assist in the construction of an appropriate questionnaire schedule. Structured questionnaires, integrated into a widerranging interviewing process, were conducted with fifty three hospital decision-makers. The data obtained were analysed using statistical and econometric techniques (SPSS and STATA). The results obtained, in addition to clarifying the professional, training and informational pathways followed by the decision-makers in question, their perceptions of the decision-making process in their institutions, indicated that there exist three distinct decision-maker profiles: (1) those who undertake and seek both training and information related to the health sector; (2) those who undertake and seek both training and information related to their management/decision-making functions; and (3) those who undertake and seek both training and information related to both the health sector and the management/ decision-making function. The composition of each of the profiles permitted the specific characteristics of each of the profiles to be specified; on the basis of this latter process, it was possible to make some recommendations regarding how the current weaknesses of the present decision-making process could best be overcome, and how the needs of effective hospital decision-making could best be satisfied in the future.
According to current orthodoxy, it is competitive mechanisms that provide the fundamental motor of economic progress. This being the case, it is hardy surprising that a series of factors have become conducive to the not infrequent importation of models from private management the public administration. This transfer obviously has its effects on the pre-existing network of inter-institutional relationships without necessarily promoting the corresponding internal reforms and adaptations in the organisations involved. The majority of transfers of this sort aim ostensibly to reduce unit costs, eliminate waste and inefficiency, and improve the quality of services, always with the focus on “promoting customer satisfaction”. The main weapon used in this permanent assault on low quality and high costs is innovation. Yet without incentives to the improvement of both the training and information on which innovations n health delivery systems depend, short term cost reductions are likely to be exceeded by the costs of health care delivery to a population that is increasingly aged and unprepared to tolerate treatment the quality of which is in any way inferior. Inevitably, constraints on the training and information inputs into health professionals’ career development give rise to a series of undesirable outcomes, including reduced quality of decision-making, greater (and not necessarily equitable) rationing of resources, and/or more discriminatory distribution of health care inputs. With the above considerations in mind, the main aim of the present research was to identify the main components that determine the profile of the typical hospital decision-maker, based on an analysis of the training received over the years, and the corresponding informational needs. To this end, using interview and questionnaire techniques, an attempt was made to specify the career-long training pathways and the corresponding informational “requirements” and “acquisitions” of hospital decision-makers, along with their perceptions regarding hospital decision-making (in general) and the role of training and information in that process (in particular). In methodological terms, the study began with the identification – in theoretical terms – of the internal and external factors that contributed to and constrained decision-making. Subsequently, formal and informal contacts were established with key informants in the hospital sector, with a view not only to validating the initial a priori assumptions regarding the decision-making process, but also to assist in the construction of an appropriate questionnaire schedule. Structured questionnaires, integrated into a widerranging interviewing process, were conducted with fifty three hospital decision-makers. The data obtained were analysed using statistical and econometric techniques (SPSS and STATA). The results obtained, in addition to clarifying the professional, training and informational pathways followed by the decision-makers in question, their perceptions of the decision-making process in their institutions, indicated that there exist three distinct decision-maker profiles: (1) those who undertake and seek both training and information related to the health sector; (2) those who undertake and seek both training and information related to their management/decision-making functions; and (3) those who undertake and seek both training and information related to both the health sector and the management/ decision-making function. The composition of each of the profiles permitted the specific characteristics of each of the profiles to be specified; on the basis of this latter process, it was possible to make some recommendations regarding how the current weaknesses of the present decision-making process could best be overcome, and how the needs of effective hospital decision-making could best be satisfied in the future.
Descrição
Tese de Doutoramento em Gestão
Palavras-chave
Estabelecimento hospitalar , Gestão , Serviços de saúde , Tomada de decisão , Gestão pública , Formação/Informação , Perfis profissionais