Avaliação do modelo de gestão de serviço de enfermagem aplicado em hospitais gerenciados por Organização Social de Saúde: um estudo de caso
Data
2020-02-10
Autores
Nishio, Elizabeth Akemi
Orientadores
D’Innocenzo, Maria
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar sob a percepção dos enfermeiros ativos, o modelo de gestão de serviço de enfermagem hospitalar aplicado em hospitais gerenciados por Organização Social de Saúde Associação Paulista para o Desenvolvimento da Medicina (OSS-SPDM), considerando-se o tipo e as dimensões do modelo. Caracterização dos sujeitos e fatores da gestão que influenciaram a percepção de governança. Método: trata-se de um estudo quantitativo, exploratório, transversal, do tipo estudo de caso único integrado e população censitária. A análise do modelo foi realizada em 15 hospitais a partir do instrumento de coleta de dados denominado Index of Professional Nursing Governance, o qual possui 86 perguntas (em escala tipo Likert de 1 a 5) que foram direcionadas aos enfermeiros ativos das instituições hospitalares do estudo. Os escores foram calculados pela soma das pontuações atribuídas pelos profissionais, resultando na indicação do tipo de modelo de gestão vigente em cada instituição. Para a consistência interna utilizou-se o coeficiente Alpha de Cronbach. A coleta de dados foi realizada on-line com link de acesso aos instrumentos, mediante declaração de concordância do Termo de Consentimento Livre e Esclarecido no período de 01 de fevereiro a 30 março de 2019. Os dados foram armazenados e organizados na plataforma REDCap, hospedada na rede da Universidade Federal de São Paulo. A análise estatística foi realizada de forma descritiva, com análise de agrupamento por método k-means, para avaliação da variabilidade interna, similaridades e diferenças entre os hospitais, e por regressão linear múltipla, a fim de analisar os efeitos simultâneos de um conjunto de variáveis sobre a pontuação alcançada no instrumento supracitado. Resultados: dos 1.523 enfermeiros convidados, 680 (44,6%) aceitaram participar do estudo, dos quais 518 (34,1%) completaram os questionários. A maioria dos participantes foi mulher (82,8%) com idade média de 36,7 anos; 81,1% tem especialização e pós graduação e 24,3% exerce algum cargo gerencial. Quanto aos resultados do instrumento de coleta, 12 hospitais obtiveram média geral de 184,3 pontos indicando governança compartilhada e três hospitais (20%) foram classificados no modelo de gestão tradicional com média geral de 165,7 pontos. Quanto à classificação dos hospitais, verificaram-se na governança compartilhada três hospitais sem certificação, com média de 187,3 pontos, cinco hospitais com certificação, com média de 187,5 pontos, três hospitais psiquiátricos, com média de 178,6 pontos, e um hospital com menos de um ano de gestão, com 176,8 pontos. Na governança tradicional observou-se um hospital com certificação (168,0 pontos), um hospital sem certificação (166,1 pontos) e um hospital com menos de um ano de gestão (163,0). Enfermeiros com cargo gerencial apresentaram, em média, percepção menor de governança compartilhada (12,4 pontos a menos) do que os profissionais sem cargos de gerência. Aqueles que trabalhavam de 11 a 20 anos sob gestão da organização social apresentaram médias maiores em relação àqueles com menos de um ano de trabalho (19,6 e 33,7 pontos, respectivamente). Conclusões: dos 15 hospitais analisados, 80% encontram-se sob a governança compartilhada, indicando que o grupo dominante possui, sobretudo, alguma participação da equipe. Por outro lado, observou-se que a percepção, por parte dos enfermeiros com cargo gerencial, da governança compartilhada foi menos expressiva ao ser comparada com a percepção dos profissionais sem cargos de gestão. Os fatores que influenciaram a percepção de governança foram o tipo de cargo e tempo de trabalho sob gestão da OSS-SPDM. Ressalta-se que o modelo de gestão de Serviço de Enfermagem em uso é hibrido, em processo de transição do modelo tradicional para modelo de governança corporativa.
Objective: To evaluate, under the perception of active nurses, the hospital nursing service management model applied in hospitals managed by the Social Health Organization Associação Paulista para a Desenvolvimento da Medicina (OSS-SPDM), considering the type and dimensions of the model. Characterization of subjects and management factors that influenced the perception of governance. Method: this is a quantitative, exploratory, cross-sectional study, of the type of integrated single case study and census population. The analysis of the model was carried out in 15 hospitals using the data collection instrument called Index of Professional Nursing Governance, which has 86 questions (on a Likert scale from 1 to 5) that were directed to active nurses in the hospital institutions in the study. The scores were calculated by adding the scores assigned by the professionals, resulting in the indication of the type of management model in force in each institution. For internal consistency, Cronbach's Alpha coefficient was used. Data collection was carried out online with a link to access the instruments, by means of a declaration of agreement from the Free and Informed Consent Term between February 1 and March 30, 2019. The data were stored and organized on the REDCap platform, hosted in the network of the Federal University of São Paulo. Statistical analysis was performed in a descriptive manner, with cluster analysis by the k-means method, to assess internal variability, similarities and differences between hospitals, and by multiple linear regression, in order to analyze the simultaneous effects of a set of variables on the score achieved in the aforementioned instrument. Results: of the 1,523 invited nurses, 680 (44.6%) agreed to participate in the study, of which 518 (34.1%) completed the questionnaires. Most participants were women (82.8%) with an average age of 36.7 years; 81.1% have specialization and graduate degrees and 24.3% hold a managerial position. As for the results of the collection instrument, 12 hospitals obtained an overall average of 184.3 points indicating shared governance and three hospitals (20%) were classified in the traditional management model with an overall average of 165.7 points. As for the classification of hospitals, there were three non-certified hospitals in the shared governance, with an average of 187.3 points, five certified hospitals, with an average of 187.5 points, three psychiatric hospitals, with an average of 178.6 points, and a hospital with less than a year of management, with 176.8 points. In traditional governance there was a hospital with certification (168.0 points), a hospital without certification (166.1 points) and a hospital with less than one year of management (163.0). Nurses with managerial positions had, on average, a lower perception of shared governance (12.4 points less) than professionals without management positions. Those who worked for 11 to 20 years under the management of the social organization had higher averages than those with less than a year of work (19.6 and 33.7 points, respectively). Conclusions: of the 15 hospitals analyzed, 80% are under shared governance, indicating that the dominant group has, above all, some participation of the team. On the other hand, it was observed that the perception, on the part of nurses with a managerial position, of shared governance was less expressive when compared with the perception of professionals without management positions. The factors that influenced the perception of governance were the type of position and time of work under management of OSS-SPDM. It is noteworthy that the Nursing Service management model in use is hybrid, in the process of transition from the traditional model to the corporate governance model.
Objective: To evaluate, under the perception of active nurses, the hospital nursing service management model applied in hospitals managed by the Social Health Organization Associação Paulista para a Desenvolvimento da Medicina (OSS-SPDM), considering the type and dimensions of the model. Characterization of subjects and management factors that influenced the perception of governance. Method: this is a quantitative, exploratory, cross-sectional study, of the type of integrated single case study and census population. The analysis of the model was carried out in 15 hospitals using the data collection instrument called Index of Professional Nursing Governance, which has 86 questions (on a Likert scale from 1 to 5) that were directed to active nurses in the hospital institutions in the study. The scores were calculated by adding the scores assigned by the professionals, resulting in the indication of the type of management model in force in each institution. For internal consistency, Cronbach's Alpha coefficient was used. Data collection was carried out online with a link to access the instruments, by means of a declaration of agreement from the Free and Informed Consent Term between February 1 and March 30, 2019. The data were stored and organized on the REDCap platform, hosted in the network of the Federal University of São Paulo. Statistical analysis was performed in a descriptive manner, with cluster analysis by the k-means method, to assess internal variability, similarities and differences between hospitals, and by multiple linear regression, in order to analyze the simultaneous effects of a set of variables on the score achieved in the aforementioned instrument. Results: of the 1,523 invited nurses, 680 (44.6%) agreed to participate in the study, of which 518 (34.1%) completed the questionnaires. Most participants were women (82.8%) with an average age of 36.7 years; 81.1% have specialization and graduate degrees and 24.3% hold a managerial position. As for the results of the collection instrument, 12 hospitals obtained an overall average of 184.3 points indicating shared governance and three hospitals (20%) were classified in the traditional management model with an overall average of 165.7 points. As for the classification of hospitals, there were three non-certified hospitals in the shared governance, with an average of 187.3 points, five certified hospitals, with an average of 187.5 points, three psychiatric hospitals, with an average of 178.6 points, and a hospital with less than a year of management, with 176.8 points. In traditional governance there was a hospital with certification (168.0 points), a hospital without certification (166.1 points) and a hospital with less than one year of management (163.0). Nurses with managerial positions had, on average, a lower perception of shared governance (12.4 points less) than professionals without management positions. Those who worked for 11 to 20 years under the management of the social organization had higher averages than those with less than a year of work (19.6 and 33.7 points, respectively). Conclusions: of the 15 hospitals analyzed, 80% are under shared governance, indicating that the dominant group has, above all, some participation of the team. On the other hand, it was observed that the perception, on the part of nurses with a managerial position, of shared governance was less expressive when compared with the perception of professionals without management positions. The factors that influenced the perception of governance were the type of position and time of work under management of OSS-SPDM. It is noteworthy that the Nursing Service management model in use is hybrid, in the process of transition from the traditional model to the corporate governance model.