A carregar...
Publicação
Facilitadores, barreiras e fatores moderadores na implementação de intervenções baseadas no valor em hospitais
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 5.08 MB | Adobe PDF |
Orientador(es)
Resumo(s)
Resumo - Introdução: Valor (eficiência) pode constituir-se como ponto de convergência entre os interesses dos profissionais e os interesses globais da organização. A transição do volume para o valor implicará uma abordagem contingencial, diagnóstico situacional e a congruência entre os elementos do sistema organizacional. A contratualização interna é construto de alinhamento organizativo para a melhoria do valor. Desconhecem-se estudos que sistematizem o conhecimento sobre os elementos que afetam, positiva ou negativamente, a transformação do modelo.
Objetivo geral: Descrever e analisar facilitadores, barreiras e fatores moderadores na implementação de intervenções baseadas no valor em hospitais
Metodologia: Para identificar facilitadores e barreiras na implementação de intervenções baseadas no valor em hospitais (objetivo 1), desenvolveu-se uma Revisão Sistemática e respetiva síntese narrativa. Para sintetizar concetualmente facilitadores e barreiras na implementação de intervenções baseadas no valor em hospitais (objetivo 1.A), recorreu-se à metodologia Gioia, produzindo-se uma síntese baseada no modelo de congruência. Para analisar fatores moderadores na implementação da contratualização interna orientada pelo valor num centro hospitalar (objetivo 2) e construir um modelo concetual de intervenções baseadas no valor em hospitais portugueses (objetivo 2.A), desenvolveu-se uma grounded theory, com recurso à metodologia Gioia.
Resultados: O Estudo 1 (objetivos 1 e 1.A) teve como resultado teórico a Síntese de uma Revisão Sistemática sobre a Implementação de Intervenções Baseadas no Valor em Hospitais: Dinâmicas Tensionais. São facilitadores: gestão do conhecimento e evolução (recursos); confiança mútua (história); cooperação para além do hospital (ambiente); desenvolvimento da inovação (trabalho); gerar e desenvolver lideranças (pessoas); partilha e aprendizagem (estrutura e processos informais); gerir talento e articulação dentro do hospital (estrutura formal); sentido de serviço ao doente (output organizacional); otimização partilhada dos processos e soluções (output grupal); ou engagement e empoderamento dos profissionais (output individual). São barreiras: falta de apoio à decisão (recursos); profissionais não comprometidos (história); barreiras nos cuidados de saúde primários (ambiente); priorização pelo urgente imediato (trabalho); domínio das velhas linhas de poder (pessoas); fronteiras internas (estrutura formal); ou ineficiência sistémica (output organizacional). O Estudo 2 (objetivos 2 e 2.A) teve como resultado teórico a Anatomia de Intervenções Baseadas no Valor em Hospitais Portugueses. A identidade organizacional explica os fenómenos observados na componente (tendencialmente) informal: buy-in, apropriação e disengagement das lideranças intermédias e operacionais (os primeiros constituindo comportamentos estratégicos autónomos); descrédito da estratégia e das lideranças. A cooperação interna explica o conjunto de fenómenos observados na componente (tendencialmente) formal: preparação, desperdício de gestão e unidades territoriais.
Discussão e conclusões: A Síntese de Dinâmicas Tensionais apresenta facilitadores e barreiras que influenciam a congruência de uma organização sob a intenção de valor, enquanto a Anatomia de Intervenções Baseadas no Valor apresenta fatores moderadores positivos e negativos na implementação de intervenções baseadas no valor em hospitais. A identificação de influências internas sugere que as organizações de saúde tendentes ao valor atentem na congruência dos seus subsistemas e focos tensionais, ainda que num ambiente favorável. A dinâmica dessas interações, relacionada com a complexidade das organizações de saúde e de cada organização em particular, poderá proporcionar novos modelos, melhorados ou, pelo contrário, limitados ou possíveis.
Implicações práticas: Relacionando-se com o caráter social e organizacional da investigação, e procurando acionar os modelos concetuais decorrentes dos Estudos desenvolvidos, propõe-se uma modificação do modelo clássico de contratualização designada Contratualização Interna Baseada no Valor e o Balanced Scorecard (BSC) de Cinco Perspetivas, uma adaptação do BSC às organizações integradas no Serviço Nacional de Saúde.
Abstract - Introduction: Value (efficiency) can be established as a point of convergence between both the interests of professionals and the overall interests of the organization. The transition from volume to value will imply a contingent approach, situational diagnosis, and the congruence between the several elements of the organizational system. Internal contractualization is an organizational alignment construct aimed at value improvement. Studies that systematize knowledge about the elements that affect, positively or negatively, the transformation of the model, are unknown. General objective: Describe and analyze facilitators, barriers and moderating factors in implementing value-based interventions in hospitals. Methodology: In order to identify facilitators and barriers in implementing value-based interventions in hospitals (objective 1), a systematic review and respective narrative synthesis was developed. In order to conceptually synthesize facilitators and barriers in implementing value-based interventions in hospitals (objective 1.A), the Gioia methodology was used, producing a synthesis based on the congruence model. In order to analyze moderating factors in implementing value-driven internal contracting in a hospital center (objective 2) and build a conceptual model of value-based interventions in Portuguese hospitals (objective 2.A), a grounded theory was developed, using the Gioia methodology. Results: Study 1 (objectives 1 and 1.A) had the Synthesis of a Systematic Review on the Implementation of Value-Based Interventions in Hospitals: Tensional Dynamics as a theory result. Facilitators are: knowledge management and evolution (resources); mutual trust (history); cooperation beyond the hospital (environment); innovation development (work); leadership generation and development (people); sharing and learning (informal structure and processes); talent management and articulation within the hospital (formal structure); sense of service to the patient (organizational output); shared optimization of processes and solutions (group output); and worker engagement and empowerment (individual output). Barriers are: lack of decision support (resources); non-committed workers (history); barriers in primary health care (environment); prioritization to what is urgent and immediate (work); dominance of old power lines (people); internal borders (formal structure); and systemic inefficiency (organizational output). Study 2 (objectives 2 and 2.A) had the Anatomy of Value-Based Interventions in Portuguese Hospitals as a theory result. Organizational identity explains the phenomena observed in the (tendentiously) informal component: buy-in, appropriation and disengagement of intermediate and operational leaderships (the former constituting autonomous strategic behaviours); and strategy and leadership discredit. Internal cooperation explains the set of the phenomena observed in the (tendentiously) formal component: preparation, management waste, and territorial units. Discussion and conclusions: The Synthesis of Tensional Dynamics presents facilitators and barriers that influence the congruence of an organization under the intention of value, while the Anatomy of Value-Based Interventions presents positive and negative moderating factors of the implementation of value-based interventions in hospitals. The identification of internal influences suggests that value-oriented health organizations are aware of the congruence of their subsystems and tensional focuses, albeit in a favourable environment. The dynamics of these interactions, related to the complexity of health organizations and of each individual organization, may provide new models either improved or, on the contrary, limited or possible. Practical implications: Relating to the social and organizational character of this research, and seeking to activate the conceptual models resulting from the studies developed, a modification of the classical contractualization model is proposed, which we call Value-Based Internal Contractualization and the Five Perspectives Balanced Scorecard (BSC), a BSC adaptation to the Portuguese National Health Service.
Abstract - Introduction: Value (efficiency) can be established as a point of convergence between both the interests of professionals and the overall interests of the organization. The transition from volume to value will imply a contingent approach, situational diagnosis, and the congruence between the several elements of the organizational system. Internal contractualization is an organizational alignment construct aimed at value improvement. Studies that systematize knowledge about the elements that affect, positively or negatively, the transformation of the model, are unknown. General objective: Describe and analyze facilitators, barriers and moderating factors in implementing value-based interventions in hospitals. Methodology: In order to identify facilitators and barriers in implementing value-based interventions in hospitals (objective 1), a systematic review and respective narrative synthesis was developed. In order to conceptually synthesize facilitators and barriers in implementing value-based interventions in hospitals (objective 1.A), the Gioia methodology was used, producing a synthesis based on the congruence model. In order to analyze moderating factors in implementing value-driven internal contracting in a hospital center (objective 2) and build a conceptual model of value-based interventions in Portuguese hospitals (objective 2.A), a grounded theory was developed, using the Gioia methodology. Results: Study 1 (objectives 1 and 1.A) had the Synthesis of a Systematic Review on the Implementation of Value-Based Interventions in Hospitals: Tensional Dynamics as a theory result. Facilitators are: knowledge management and evolution (resources); mutual trust (history); cooperation beyond the hospital (environment); innovation development (work); leadership generation and development (people); sharing and learning (informal structure and processes); talent management and articulation within the hospital (formal structure); sense of service to the patient (organizational output); shared optimization of processes and solutions (group output); and worker engagement and empowerment (individual output). Barriers are: lack of decision support (resources); non-committed workers (history); barriers in primary health care (environment); prioritization to what is urgent and immediate (work); dominance of old power lines (people); internal borders (formal structure); and systemic inefficiency (organizational output). Study 2 (objectives 2 and 2.A) had the Anatomy of Value-Based Interventions in Portuguese Hospitals as a theory result. Organizational identity explains the phenomena observed in the (tendentiously) informal component: buy-in, appropriation and disengagement of intermediate and operational leaderships (the former constituting autonomous strategic behaviours); and strategy and leadership discredit. Internal cooperation explains the set of the phenomena observed in the (tendentiously) formal component: preparation, management waste, and territorial units. Discussion and conclusions: The Synthesis of Tensional Dynamics presents facilitators and barriers that influence the congruence of an organization under the intention of value, while the Anatomy of Value-Based Interventions presents positive and negative moderating factors of the implementation of value-based interventions in hospitals. The identification of internal influences suggests that value-oriented health organizations are aware of the congruence of their subsystems and tensional focuses, albeit in a favourable environment. The dynamics of these interactions, related to the complexity of health organizations and of each individual organization, may provide new models either improved or, on the contrary, limited or possible. Practical implications: Relating to the social and organizational character of this research, and seeking to activate the conceptual models resulting from the studies developed, a modification of the classical contractualization model is proposed, which we call Value-Based Internal Contractualization and the Five Perspectives Balanced Scorecard (BSC), a BSC adaptation to the Portuguese National Health Service.
Descrição
Palavras-chave
Efficiency, Organizational Models, Organizational Contratualização interna Grounded Theory Barreiras e facilitadores Internal contracting Grounded Theory Barriers and facilitators