Avaliação da qualidade em hospitais de Salvador gerenciados por organizações sociais

Abstract

This dissertation aims to evaluate how the state hospitals of Salvador, managed by Social Health Organizations, ensured the quality of care, according to the quality indicators established in the Management Contract, in the period from 2017 to 2019. To this end, the hospital network in Bahia under the management of Social Health Organizations was characterized, selecting state hospitals in Salvador managed by Social Organizations and identifying how the management contract indicators approach or distance themselves from the National Accreditation Organization standards. Exploratory, descriptive research was carried out with a qualitative approach. Managers of the Secretary of Health of Bahia State and Hospitals were interviewed, documentary analysis and secondary data were performed, using the data from surveys applied by Social Health Organizations between 2017 and 2019 as a result indicator on user satisfaction. Results indicate that the management model by Social Organizations is predominant in the State hospital network, with seven Social Organizations participating in this program in the management of 18 hospitals, 33% of which are based in Salvador; the management contract adopted does not establish indicators capable of evaluating the structure or the care process, which weakens the state's regulatory power, as it does not have an evaluation system that allows the results of these services to be evaluated. Although hospital managers recognize advances produced by this type of management in the network's hospitals, they mention limitations in the physical structure and in the provision of hospital medical equipment in those units, in addition to difficulties in maintaining the dimensioning of personnel appropriate to their functioning. In the perspective of the manager of the State Health Secretariat of Bahia, there are problems in the physical structure of the building, however, he considers that there have been advances with regard to the technological park of state public hospitals; he also recognizes that the planning of contractual goals and the evaluation system are factors that hinder quality assurance in these hospitals. In the conception of state management, the model's potential is the possibility of contracting a service that meets the needs of users of the Unified Health System. In this sense, it is proposed that the Secretary of Health of Bahia State adapt the Health System Quality assessment constant in contracts, adopting indicators that evaluate the results, not only based on the measure of efficiency and user satisfaction, but also considering aspects of patient safety and the requirements of the National Accreditation Organization for accreditation of level 1 hospitals.