Desenvolvimento do mapa estratégico como diretriz de gestão em serviço de fisioterapia hospitalar / Development of a strategic map as a management guideline in hospital-based physiotherapy

Trata-se de um relato de caso abordando a experiência de um projeto de gestão desenvolvido na Divisão de Fisioterapia do Instituto Central do Hospital das Clí­nicas da Faculdade de Medicina da Universidade de São Paulo. A gestão de serviços de saúde é complexa e desafiadora, devido a fatores como as constantes transformações tecnológicas e terapêuticas, aumento da população idosa e de doenças crônicas, escassez de recursos e carência de gestão eficiente nas organizações. A definição de objetivos, estratégias e instrumentos de monitoramento para direcionar a organização e promover qualidade são determinantes nas ações gerenciais e no desempenho estratégico da empresa. Neste contexto, o projeto objetivou construir um mapa estratégico considerando o Balanced ScoreCard como diretriz gerencial e instrumento de análise do desempenho da Divisão de Fisioterapia. Reuniões estruturadas com membros da liderança de fisioterapia foram realizadas para definir a visão do futuro e objetivos estratégicos a médio e longo prazo, idealizados pela Divisão de Fisioterapia, tendo como base as perspectivas do Balanced ScoreCard, aprendizado e crescimento, processos internos, clientes, sustentabilidade financeira e social. O mapa estratégico foi construí­do em uma representação gráfica permitindo fácil compreensão da visão do futuro e objetivos estratégicos que irão direcionar o comportamento e o desempenho da Divisão de Fisioterapia, nos próximos anos. Além de direcionar as ações de melhorias da Divisão, o mapa estratégico elaborado também apresenta caracterí­sticas marcantes de alinhamento com o mapa estratégico institucional. (AU)

This is a case report addressing a management project developed in the Physiotherapy Division of the Central Institute of Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Managing health services is complex and challenging due to factors such as constant technological and therapeutic changes, increase in the elderly population and chronic diseases, scarcity of resources, and lack of efficient organizational management. The definition of objectives, strategies, and monitoring tools to direct the organization and promote quality help to determine managerial actions and the strategic performance of the service. In this context, this project aimed to build a strategic map using the Balanced Scorecard as a managerial guideline and instrument of performance analysis for the Physiotherapy Division. Structured meetings with members of the physiotherapy leadership team were held to define the vision for the future and strategic medium - and long-term objectives. The strategic map was built as a graphical representation, allowing for easy understanding of the vision for the future and strategic objectives that will guide the behavior and performance of the Physiotherapy Division in the coming years. In addition to directing the improvement actions of the division, the strategic map also presents striking instances of alignment with the institutional strategic map.(AU)

Effects of individual and group exercise programs on pain, balance, mobility and perceived benefits in rheumatoid arthritis with pain and foot deformities.

[Purpose] To verify the effects of individual and group exercise programs on pain, balance, mobility and perceived benefits of rheumatoid arthritis patients (RA) with pain and foot deformities. [Subjects and Methods] Thirty patients with RA pain and foot deformity were allocated into two groups: G1: individual exercise program and G2: group exercise program. The variables analyzed were Numerical Rating Scale (NRS) for pain, Berg Balance Scale (BBS) for balance, Timed Up & Go Test (TUG) and Functional Reach (FR) for mobility, and Foot Health Status Questionnaire (FHSQ-Br) for perceived benefits. Both exercise programs consisted of functional rehabilitation exercises and self-care guidance aimed at reducing pain and improving balance and mobility. Intragroup comparisons of variables between A1 (pre-intervention) and A2 (post-intervention) were performed. [Results] Patients in both groups were similar in A1 (pre-intervention) in all the variables analyzed. Comparison between A1 and A2 for each variable showed improvement for G1 in the NRS, BBS, FR, TUG and in four out of ten domains of FHSQ-Br. G2 showed improvement in the NRS, BBS and eight out of ten domains of FHSQ-Br. [Conclusion] Both individual and group programs revealed benefits for patients with RA, however, group exercise programs showed better perception of benefits.