Estudo de viabilidade para adoção do método Lean Six Sigma em um Hospital Público

Abstract

Managing hospitals has been a challenging and complex task for managers. Therefore, several strategic management tools and methodologies have been used to achieve better care results and even to identify and solve management problems, among them we can highlight Lean Six Sigma (LSS). LSS has been widely discussed in healthcare organizations. However, the line of studies about its applicability in nursing services is still incipient. These professionals are considered a key point both for the achievement of goals related to the improvement of hospital performance, and for its failure, since they have notorious relevance for the peculiarity of their activities with patients, for their numerical representativeness, besides being the professional category that stays longer working next to the patient. The objective of this study was to analyze the organizational viability of implementing the Lean Six Sigma model in the nursing service as an associative practice to the management model of the nursing professionals of a public hospital. This is a particular case study developed in the nursing service of a public hospital in the metropolitan region of Belo Horizonte. A mixed approach was used, employing quantitative (questionnaire) and qualitative (interview) techniques. It applied an online semi-structured questionnaire using the Surveymonkey platform. For the selection of the participants in the questionnaire, nursing professionals who work in the hospital were chosen, as well as other professionals who are part of the multiprofessional team of patient care, and professionals who perform administrative, advisory, and support activities for the hospital service. After collecting the questionnaire, the data were tabulated and analyzed regarding the frequency of answers and comparison of proportions. On the other hand, for the interview, the employees who occupy functions in the top management and technical-administrative superintendencies and are in positions at the strategic and tactical level in the hospital were considered. The interview data were analyzed using the thematic categorical content analysis technique. In the exploration of the material, the coding and categorization of the transcripts' content was conducted. In this process, the ATLAS TI® and IRAMUTEQ® software resources were used. The criteria used to define the codes were the principles of representativeness, homogeneity, exclusivity, pertinence to the research problem and proposed objectives along with the registration units defined from the theme, the meaning, the subject's reference and the event or fact recorded in the message. Next, the resource of color attribution was used to help in the labeling of codes to the themes. Thus, it was possible to organize the information as to the perceptions extracted from the excerpts of the transcriptions. The study had 285 participants, 277 through the questionnaire and eight through interviews. Most of them have completed higher education and occupy operational functions with the patient (42.81% nursing technicians; 14.04% nurses, followed by 12.63% physicians). The nursing service competences most cited as essential for improving work processes and improving hospital performance were professional posture (67.1%), followed by technical ability (56.7%). The least mentioned was leadership (33.9%). The hospital was rated as more or less organized by 47.6% of the participants.The infrastructure (60.3%), followed by the practices aimed at training and qualification (50.5%) were the main aspects related to the weaknesses and difficulties of the hospital, and these weaknesses were related to the lack of strategic planning. Another critical point to be highlighted is that most of the interviewees (47.5%) reported that the hospital performance has improved in the last three years, they believe and realize the real commitment of management and leadership in seeking to promote better working conditions and improve processes. In the analysis of the interviews' content associated with the answers from the questionnaire it was possible to identify as main obstacles to the adoption of the LSS: inequalities in performance and conflicts among professionals; low motivation on the part of the professionals; organizational culture focused on traditionalism; centralization of management; lack of organizational communication, besides managerial and operational weaknesses. As facilitating aspects, the following stand out: the commitment and engagement of the professionals and the promotion and professional education. The results of this study point to the current momentary unfeasibility of adopting the Lean Six LSS method in the nursing service of the hospital studied due to the absence of elements that make up the principles and guidelines of this method that are necessary for its adoption and sustainability. The technical product resulting from this study was a conclusive technical report to support the managers of the hospital studied in which conditions should be established or improved to implement and maintain the sustainability of the Lean Six Sigma method in the hospital.