ABSTRACT
Background: As of December 31, 2020, Brazil had the second-highest burden of COVID-19 worldwide. Given the absence of federal government coordination, it was up to the local governments to maintain healthcare provision for non-COVID health issues. In this descriptive study, we aimed to discuss the SUS functionality and resilience, describing the impact of the pandemic on non-COVID health services delivery while considering the regional inequalities of the allocation of financing health system, health infrastructure and health workforce. Methods: We used input-output framework based on the World Health Organization (WHO) Health System Building Blocks to estimate health system functionality and resilience. An ecological assessment was designed to calculated mean relative changes to compare the first year of the pandemic in Brazil with the previous one. All data used in this study were anonymized and made available by the Brazilian Ministry of Health. Input indicators were categorized in health system financing (federal funding received as well as expenditure of both state and city governments), health system's infrastructure (hospital beds) and health workforce (healthcare workers positions). Output indicators were categorized into nine different groups of service delivery procedures. To explore the relationship between the variation in procedures with socioeconomic conditions, we used the Socioeconomic Vulnerability Index (SVI). Findings: State governments had a 38·6% increase in federal transfers, while municipal governments had a 33·9% increase. The increase of ICU beds reached its peak in the third quarter of 2020, averaging 72·1% by the end of the year. The country also saw an increase in jobs for registered nurses (13·6%), nurse assistants (8·5%), physiotherapists (7·9%), and medical doctors (4·9%). All procedures underwent expressive reduction: Screenings (-42·6%); Diagnostic procedures (-28·9%); Physician appointments (-42·5%); Low and medium complexity surgeries (-59·7%); High complexity surgeries (-27·9%); Transplants (-44·7%); Treatments and clinical procedures due to injuries of external causes (-19·1%); Irrepressible procedures (-8·5%); and Childbirths (-12·6%). The most significant drop in procedures happened in the first quarter of the pandemic, followed by progressive increase; most regions had not yet recovered by the end of 2020. State-level changes in numbers of procedures point towards a negative trend with SVI. Interpretation: The Brazilian Government did not consider that socioeconomically vulnerable states were at a higher risk of being impacted by the overburden of the health system caused by the COVID-19, which resulted in poorer health system functionality for those vulnerable states. The lack of proper planning to improve health system resilience resulted in the decrease of a quarter of the amount of healthcare procedures increasing the already existing health disparities in the country. Funding: MCTIC/CNPQ/FNDCT/MS/SCTIE/DECIT No 07/2020.
ABSTRACT
This paper aims at proposing validated principles to underpin clinical management as a means to transform healthcare for integrated healthcare systems. The starting point was the conception of clinical management based on structuring elements that do not separate management, care and education. The authors' proposal was submitted to specialists so that a consensus could be reached. At the end of the process, the following principles of clinical management were presented: (1) Focus on health needs and comprehensive care, (2) Quality and safety in healthcare, (3) Articulation and legitimation of different health practices and types of knowledge to face health problems, (4) Power sharing and co-accountability among managers, health professionals and citizens in healthcare production; (5) Education of people and organizations; (6) Focus on outcomes that add value to health and life; (7) Transparency and accountability regarding collective interests. It is concluded that the principles of clinical management express connections that shed new light on management, healthcare, and education in integrated healthcare systems, requiring critical awareness in relation to the simultaneity of "permanence" and change in practices.
O artigo objetiva propor princípios validados que norteariam uma gestão da clínica voltada à transformação da atenção à saúde, para sistemas integrados de saúde. Partiu-se da concepção de gestão da clínica configurada a partir de certos elementos estruturantes que não separam gestão, cuidado e educação. A proposta dos autores passou por processo de estabelecimento de consenso entre especialistas convidados. Como resultados, são apresentados os seguintes princípios da gestão da clínica: (1) Orientação às necessidades de saúde e à integralidade do cuidado; (2) Qualidade e segurança no cuidado em saúde; (3) Articulação e valorização dos diferentes saberes e práticas em saúde para o enfrentamento dos problemas de saúde; (4) Compartilhamento de poder e corresponsabilização entre gestores, profissionais de saúde e cidadãos na produção da atenção em saúde; (5) Educação de pessoas e da organização; (6) Orientação aos resultados que agreguem valor à saúde e à vida e (7) Transparência e responsabilização com os interesses coletivos. Conclui-se que os princípios da gestão da clínica expressam conexões que lançam uma nova luz sobre a gestão, atenção à saúde e educação em sistemas integrados e demandam uma consciência crítica em relação à simultaneidade de permanências e mudanças de práticas.
Subject(s)
Comprehensive Health Care/organization & administration , Delivery of Health Care, Integrated/organization & administration , Delivery of Health Care/organization & administration , Health Personnel/organization & administration , Brazil , Health Personnel/education , Health Services Needs and Demand , Humans , National Health Programs/organization & administrationABSTRACT
Resumo O artigo objetiva explorar a conceituação da gestão da clínica visando à compreensão dos diversos sentidos que poderão ser atribuídos a essa expressão. Essa discussão tanto pode contribuir para o planejamento e a organização dos serviços de saúde voltados para a gestão da clínica, quanto no estabelecimento de princípios para a elaboração de ações nessa área. Metodologicamente, o estudo consiste numa revisão bibliográfica de cunho qualitativo, com descritores da Biblioteca Virtual em Saúde (BVS). Em termos de resultados, destacam-se sete temas que sintetizam a análise das fontes: gestão, promoção da qualidade, monitoramento ou auditoria clínica, educação, responsabilidade, segurança no cuidado e dimensão sistêmica. Conclui-se que a variação de sentidos relaciona-se à forma como os autores dos estudos revisados expressam ou desdobram os componentes conceituais estruturantes amplamente aceitos como governança clínica. Observase que falta um maior foco em discussões sobre o planejamento e as políticas relacionadas à governança clínica.
Abstract The article aims to explore the concept of clinical management, with a view towards understanding the diverse meanings that could be attributed to that expression. This discussion can contribute to the planning and organization of health services geared to the management of clinical practices, as well as to set forth principles to draft actions in that field. Methodologically, the study consists of a qualitative literature review, using keywords of the Virtual Health Library (VHL). In terms of results, seven topics stand out that synthesize the analysis of sources: management, quality promotion, clinical monitoring or auditing, education, responsibility or accountability, safety in care and a systemic dimension. The conclusion is that the variation of meanings relates to the way in which the authors of the studies reviewed express or unfold the structuring conceptual components broadly accepted as clinical governance. What we observe is a lack of a greater focus on discussions regarding planning and policies relating to clinical governance.
Subject(s)
Humans , Clinical Governance , Health ServicesABSTRACT
The article aims to explore the concept of clinical management, with a view towards understanding the diverse meanings that could be attributed to that expression. This discussion can contribute to the planning and organization of health services geared to the management of clinical practices, as well as to set forth principles to draft actions in that field. Methodologically, the study consists of a qualitative literature review, using keywords of the Virtual Health Library (VHL). In terms of results, seven topics stand out that synthesize the analysis of sources: management, quality promotion, clinical monitoring or auditing, education, responsibility or accountability, safety in care and a systemic dimension. The conclusion is that the variation of meanings relates to the way in which the authors of the studies reviewed express or unfold the structuring conceptual components broadly accepted as clinical governance. What we observe is a lack of a greater focus on discussions regarding planning and policies relating to clinical governance.
Subject(s)
Clinical Governance , Health Services , HumansABSTRACT
This paper addresses different aspects related to the use of external evaluation models of health services in Brazil, especially hospital accreditation. It is based upon the author´s experience in implementing quality evaluation models in hospitals, as well as on her master and PhD works. The author presents a few aspects concerning the impact of the use of these models in hospitals and the specificities of their application. The results are listed: management enhancement, standardization of processes, personnel training, teamwork, patient-focused care, motivation, external recognition, culture change. The author points out the sundry aspects concerning the way such models are used in Brazilian hospitals.
Subject(s)
Hospital Administration , Hospitals/standards , Models, Theoretical , Quality Assurance, Health Care , Brazil , Evaluation Studies as Topic , HumansABSTRACT
Este artigo aborda aspectos relacionados ao uso de modelos de avaliação externa de serviços de saúde no Brasil, sobretudo acreditação hospitalar, a partir da experiência da autora com a implementação de modelos de avaliação da qualidade em hospitais, bem como de sua reflexão sobre acreditação enquanto objeto de estudo da pós-graduação. A autora aponta alguns dos resultados do uso destes modelos em hospitais e as especificidades de sua aplicação. Esses resultados são enumerados: aprimoramento da gestão, padronização de processos, treinamento de pessoal, trabalho em equipe, atenção focada no paciente, motivação, reconhecimento externo, mudança de cultura. A autora problematiza o modo como tais modelos têm sido empregados nos hospitais brasileiros.
This paper addresses different aspects related to the use of external evaluation models of health services in Brazil, especially hospital accreditation. It is based upon the author´s experience in implementing quality evaluation models in hospitals, as well as on her master and PhD works. The author presents a few aspects concerning the impact of the use of these models in hospitals and the specificities of their application. The results are listed: management enhancement, standardization of processes, personnel training, teamwork, patient-focused care, motivation, external recognition, culture change. The author points out the sundry aspects concerning the way such models are used in Brazilian hospitals.
Subject(s)
Humans , Hospital Administration , Hospitals/standards , Models, Theoretical , Quality Assurance, Health Care , Brazil , Evaluation Studies as TopicABSTRACT
O trabalho reúne experiências de hospitais brasileiros em gestão da qualidade, inspiradas em diferentes modelos de avaliação externa. Discute qualidade em saúde e a situação hospitalar brasileira, com o intuito de caracterizar o ambiente no qual as iniciativas de qualidade em instituições de saúde são desenvolvidas. As diferentes abordagens de gestão da qualidade são apresentadas, comparadas e discutidas. Os resultados destas são apontados, bem como seu modo de implementação e suas especificidades. A importância da qualidade para o contexto da saúde e as diferentes possibilidades de interação com a gestão organizacional são discutidas.This study presents different Brazilian hospitals experiences in quality in healthcare, all of which based on external evaluation models. It discusses various aspects of quality in healthcare, specially the ones concerning the Brazilian hospital context, aiming at characterizing the ambience surrounding quality initiatives in healthcare organizations. The author also presents, compares and discusses different quality management approaches, pointing out its results, implementation processes and specificities. Finally, the study also intends to discuss the importance of quality in the healthcare context as well as its relationship with organizational management...
Subject(s)
Health Services Research , Total Quality Management , Total Quality Management/methods , Quality Assurance, Health Care , Health Facility Administrators , Health Services , Health Services Administration , Hospitals, Private , Hospitals, Public , Models, Organizational , Delivery of Health Care , Quality of Health CareABSTRACT
O trabalho reúne experiências de hospitais brasileiros em gestão da qualidade, inspiradas em diferentes modelos de avaliação externa. Discute qualidade em saúde e a situação hospitalar brasileira, com o intuito de caracterizar o ambiente no qual as iniciativas de qualidade em instituições de saúde são desenvolvidas. As diferentes abordagens de gestão da qualidade são apresentadas, comparadas e discutidas. Os resultados destas são apontados, bem como seu modo de implementação e suas especificidades. A importância da qualidade para o contexto da saúde e as diferentes possibilidades de interação com a gestão organizacional são discutidas.This study presents different Brazilian hospitals experiences in quality in healthcare, all of which based on external evaluation models. It discusses various aspects of quality in healthcare, specially the ones concerning the Brazilian hospital context, aiming at characterizing the ambience surrounding quality initiatives in healthcare organizations. The author also presents, compares and discusses different quality management approaches, pointing out its results, implementation processes and specificities. Finally, the study also intends to discuss the importance of quality in the healthcare context as well as its relationship with organizational management...
Subject(s)
Health Services Research , Total Quality Management , Total Quality Management/methods , Quality Assurance, Health Care , Health Facility Administrators , Health Services Administration , Hospitals, Private , Hospitals, Public , Models, Organizational , Quality of Health CareABSTRACT
Recuperaçäo histórica dos antecedentes da Acreditaçäo Hospitalar no Brasil com objetivo de contextualizar historicamente o tema como metodologia de avaliaçäo de serviços de saúde, sua origem nos Estados Unidos e disseminaçäo no Brasil. Aborda o conceito de acreditaçäo e termos relacionados. Aponta e analisa as iniciativas brasileiras de avaliaçäo externa de serviços de saúde desde 1941 até os dias atuais. O trabalho dos vários grupos que se dedicam à acreditaçäo säo relatados, suas experiências, metodologias e instrumentos. As características do processo de acreditaçäo e suas implicaçöes säo enumeradas e analisadas. Discute ainda o papel de regulaçäo a ser exercido pelo Estado. A prática da avaliaçäo é relacionada ao exercício da cidadania. As dificuldades para a implementaçäo da avaliaçäo de serviços de saúde é associada ao estágio atual da cidadania
Subject(s)
Credentialing/history , Quality Assurance, Health Care/standards , Hospitals , Health Facilities/history , Brazil , Health Services Research , Licensure, Hospital/historyABSTRACT
Recuperaçäo histórica dos antecedentes da Acreditaçäo Hospitalar no Brasil com objetivo de contextualizar historicamente o tema como metodologia de avaliaçäo de serviços de saúde, sua origem nos Estados Unidos e disseminaçäo no Brasil. Aborda o conceito de acreditaçäo e termos relacionados. Aponta e analisa as iniciativas brasileiras de avaliaçäo externa de serviços de saúde desde 1941 até os dias atuais. O trabalho dos vários grupos que se dedicam à acreditaçäo säo relatados, suas experiências, metodologias e instrumentos. As características do processo de acreditaçäo e suas implicaçöes säo enumeradas e analisadas. Discute ainda o papel de regulaçäo a ser exercido pelo Estado. A prática da avaliaçäo é relacionada ao exercício da cidadania. As dificuldades para a implementaçäo da avaliaçäo de serviços de saúde é associada ao estágio atual da cidadania (AU)
Subject(s)
Credentialing/history , Health Facilities/history , Hospitals/history , Licensure, Hospital/history , Health Services , Brazil , Public Health/historyABSTRACT
Aborda questöes de qualidade na gestäo de saúde, a aplicaçäo de avaliaçäo, bem como indicadores e outras questöes pertinentes (MC)
