O protocolo clínico e o custeio baseado em atividades: um estudo do processo de tratamento da úlcera por pressão na Fundação Hospitalar do Estado de Minas Gerais

Abstract

This research aims to investigate how Clinical Protocol and Activity-Based Costing perform when used together in understanding the Pressure Ulcer Treatment process at the Hospital Foundation of the State of Minas Gerais (FHEMIG). This is an exploratory research with a qualitative and quantitative approach. Case study was the applied method. Through desk research, semi-structured interviews and focus groups, the Clinical Protocol processes for Pressure Ulcers at FHEMIG were mapped out. The Costing Based on Pressure Ulcer Treatment Activities at the Intensive Care Unit (ICU) Adult and the Extended Care Unit (UCP) of FHEMIG’s João XXIII Hospital (HJXXIII) was carried out through observations, semi-structured interviews and focus groups. The mapping of the processes was validated in expert panels. The direct costs (equipment and personnel costs) were allocated in the activities. The Integrated Hospital Management System of FHEMIG and the Information Warehouse of the Public Administration of the State of Minas Gerais (SIAD) provided the direct cost values. Indirect costs were not included in costing due to the difficulty in collecting data to define the drivers. The mapping of the Clinical Protocol processes and the Activity-Based Costing were compared. The results show that Clinical Protocol and Activity-Based Costing are complementary management tools in understanding the process of Pressure Ulcer Treatment at FHEMIG. This research intends to (1) contribute to the update of FHEMIG’s Pressure Ulcer Clinical Protocol, (2) support management in identifying strategic activities and guiding the decision making. By doing so, this research aims to have an impact on the quality of patient care, considering FHEMIG’s sustainability.