Conferência de Alexandre Lourenço sobre "Administração Hospitalar no séc. XXI: O que nos falta?", proferida nas Conferências de Valor da Associação Portuguesa de Administradores Hospitalares, a 25 de março de 2023. A conferência pode ser vista aqui: https://youtu.be/v4YulXVTC-g
1. Administração Hospitalar
no séc. XXI: O que nos falta?
25.03.2023
12h00
Centro Cultural Vila Flor, Guimarães
Alexandre Lourenço
CHUC/ NOVA ENSP
Autor
6. Hospitais de agudos
ORIGEM DOS
CUIDADOS
AUMENTO DA ESPECIALIZAÇÃO
fora dentro
DESENVOLVIMENTO
CURA
distante
7. Hospitais de agudos
ORIGEM DOS
CUIDADOS
distante
próximo
fora dentro
DESENVOLVIMENTO
CURA
MATURIDADE COM
CONTROLO
8. Necessitamos não só́ dos edifícios e do seu recheio,
mas sobretudo de bons médicos, bons enfermeiros
e bom pessoal administrativo.
A formação técnica dos médicos e a dos
enfermeiros está entregue a escolas próprias. Mas o
pessoal administrativo, esse é que, até hoje, não
tem onde aprenda nem quem o ensine (...). Entre
nós, tirando duas ou três exceções, vivemos em
pleno domínio do amadorismo e das improvisações
que, embora bem intencionadas, estragam muito
dinheiro que é sangue da nação (...).
9. Hospitais de agudos
ORIGEM DOS
CUIDADOS
próximo
fora dentro
DESENVOLVIMENTO
CURA
MATURIDADE COM
CONTROLO
TOMADA DE
CONTROLO PELA
COMUNIDADE?
ESCALADA DE CUSTOS
11. TOPO ESTRATÉGICO
CENTRO OPERACIONAL
CONSELHO DE
ADMINISTRAÇÃO
PRESIDENTE
DIRETORES DE SERVIÇO
TECNO-
ESTRUTURA APOIO
LOGÍSTICO
PLANIFICAÇÃO
DA PRODUÇÃO
CONTABILIDADE
CONTROLE
FORMAÇÃO
CONSELHO
JURÍDICO
RELAÇÕES
PÚBLICAS
SERVIÇO
SOCIAL
PROFISSIONAIS DE SAÚDE
Todos os que
dão apoio em
áreas não
relacionadas
com o processo
de trabalho
45. HIGH-LEVEL REGIONAL MEETING ON HEALTH AND CARE WORKFORCE IN EUROPE: TIME TO ACT
“Capable” doctors
51
14
-61
-76
-10,000%
-7,500%
-5,000%
-2,500%
0%
2,500%
Productivity Signs of Burnout Planning leave current
employer
(1)the decision-making latitude they need to provide high-quality care and
(2)the necessary tools and resources.
Schlesinger and Josh Gray 2017 Harvard Business Review
46. HIGH-LEVEL REGIONAL MEETING ON HEALTH AND CARE WORKFORCE IN EUROPE: TIME TO ACT
“Our practice values teamwork more
than individual performance”
52
3X more “capable”
5X more willing to go above and beyond in their jobs
-75%
less likely to say they experience significant signs of
burnout
5X recommend and stay with their organizations
Schlesinger and Josh Gray 2017 Harvard Business Review
47. HIGH-LEVEL REGIONAL MEETING ON HEALTH AND CARE WORKFORCE IN EUROPE: TIME TO ACT 53
Adapted from Walshe et al (2016)
Liderança
Supervisor's support
Team working
Job design
Work pressure
Having a challenging role
Feeling valued by
colleagues
Overall engagement
Advocacy
Intrinsic engagement
Involvement/ proactivity
Employee reactions
Health and well-being
Stress
Organizational
performance
Quality of services
Financial performance
Absenteeism
Patient mortality rate
Patient satisfaction
The link between HR strategies, staff engagement and patient
safety
48.
49.
50. Que erros cruéis às vezes são
cometidos por bons homens e
mulheres em assuntos sobre os quais
nada sabem e pensam que sabem
muito.
Notes de l'éditeur
Previsão de tendências
Embora o futuro seja repleto de incertezas e disrupções (Cambridge Dictionary 2020a), os gestores devem fazer certas suposições sobre ele para poder planejar. Essas premissas são baseadas em previsões que fornecem informações essenciais ao processo de planeamento.
A previsão é feita examinando os ambientes externo e interno em busca de informações úteis. inerente a todo planeamento, o sucesso de um empreendimento depende muito da habilidade da administração, primeiro na previsão e depois na preparação para as condições futuras.
The modern hospital results from the differentiation and technological development of the second half of the 20th century. Over the last 70 years, these new cathedrals have given a new focus to our lives: we are born, live, and die in the hospital. The hospital changed and prolonged our lives.
A system that is more and more detached from individual and population needs. Ignoring that today’s needs are quite different from those observed in the recent past.
Population aging and multimorbidity,
the increase in citizens’ expectations,
fiscal constraints in a context of low economic growth,
the emergence and re-emergence of infectious diseases, or even the digital society, pose new and essential challenges to a structurally inflexible and rigid health system.
A system that has proven incapable of promoting health and preventing disease, eliminating variability and inequity in access, and providing integrated care focused on people’s needs.
A system like this bridge in Choluteca, Honduras, could not adjust to the river course.
While most workforce attrition comes from retirement, workers als Irop out of the workforce for other reasons, including death and time take off to raise children, to care for elderly family members, or to pursue add tonal training. Sometimes this break becomes permanent, but many return to the workforce. Like retirement decisions, workforce retention rates ar often cyclical with the economy. For example, nurses tend to stay in the workforce during economic downturns, presumably to offset a decline i earnings by their spouses (Stager, Auerbach, and Buerhaus 2012). Nurse workforce retention rates have also been shown to be sensitive to changes in wages. As wages increase, workforce participation rates increase (Buerhau:
Auerbach, and Staiger 2007). Modeling attrition from the workforce due t economic factors is difficult because economic conditions cannot be antic pated. To overcome this difficulty, analysts often assume an average attritio rate that evens out boom and bust cycles over the projection period.
Hire new workers
• Increase the amount of time that workers provide patient care
• Retain workers who would have otherwise retired or left the organization
• Develop skills of workers within organization
While most workforce attrition comes from retirement, workers als Irop out of the workforce for other reasons, including death and time take off to raise children, to care for elderly family members, or to pursue add tonal training. Sometimes this break becomes permanent, but many return to the workforce. Like retirement decisions, workforce retention rates ar often cyclical with the economy. For example, nurses tend to stay in the workforce during economic downturns, presumably to offset a decline i earnings by their spouses (Stager, Auerbach, and Buerhaus 2012). Nurse workforce retention rates have also been shown to be sensitive to changes in wages. As wages increase, workforce participation rates increase (Buerhau:
Auerbach, and Staiger 2007). Modeling attrition from the workforce due t economic factors is difficult because economic conditions cannot be antic pated. To overcome this difficulty, analysts often assume an average attritio rate that evens out boom and bust cycles over the projection period.
Hire new workers
• Increase the amount of time that workers provide patient care
• Retain workers who would have otherwise retired or left the organization
• Develop skills of workers within organization