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Gestão Hospitalar em Portugal: análise dos efeitos da pandemia COVID-19 no desempenho das unidades do Serviço Nacional de Saúde (SNS)
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Abstract(s)
Em de março de 2020, Portugal, tal como o resto do mundo, teve pela frente o desafio de uma pandemia. Na resposta à pandemia, os cuidados hospitalares estiveram no epicentro. Na maioria dos países e regiões atingidas pelo COVID-19, as unidades hospitalares atingiram a sua capacidade máxima, a qual, associada a uma severa escassez de recursos humanos colocou um desafio sem precedentes à gestão hospitalar. O contexto pandémico teve um forte impacto na produção hospitalar do SNS, registando-se uma redução da atividade hospitalar. Devido ao contexto de elevada complexidade e incerteza decorrente da pandemia por COVID-19, os domínios do acesso, eficiência e qualidade dos cuidados hospitalares estiveram debaixo de foco. O presente estudo teve como objetivo central verificar o efeito da pandemia de COVID19 no desempenho da gestão dos cuidados hospitalares do SNS. E por forma, a aprofundar o conhecimento dos efeitos da pandemia, realizou-se uma análise do seu impacto nos resultados de eficiência técnica, nos diferentes modelos de organização e de gestão das unidades hospitalares, bem como nas estratégias adotadas para fazer face à pandemia. Por último, realizou-se uma análise à influência da qualidade dos cuidados hospitalares e da disponibilidade de recursos nos resultados eficiência. A amostra destes estudo foi composta por 32 unidades hospitalares, das quais 31 EPE (21 Centros Hospitalares e 11 Hospitais singulares) e uma PPP. Metodologicamente, na componente quantitativa do estudo, recorreu-se à técnica Data Envelopment Analisys para apurar os resultados de eficiência técnica, e à correlação de Sperman e à Regressão Linear Múltipla para verificar o efeito da qualidade dos cuidados hospitalares na eficiência. Para verificar efeitos da disponibilidade de recursos nos resultados eficiência utilizou-se a regressão de Tobit. Na componente qualitativa do estudo, recorreu-se a entrevistas semiestruturadas, analisadas com base na análise de conteúdo para avaliar a perceção dos entrevistados, relativamente, a fatores que influenciaram a eficiência, qualidade dos cuidados e quais as estratégias adotadas durante a pandemia. Como principais resultados, verificou-se que: i) no primeiro ano da pandemia, o score de eficiência técnica das unidades hospitalares variou entre 0,475 e 1,205, e no segundo ano a variação foi entre 0,508 e 1,219. Não existindo diferenças significativas na eficiência técnica média entre o período pré-pandémico (0,840) e o período pandémico (0,847); ii) as principais estratégias para manter a produção hospitalar foram a realocação de espaços físicos, o uso da telemedicina, o alargamento de horários e a colaboração com entidades externas, como, entidades privadas e militares para aumentar a capacidade de resposta; iii) os indicadores de qualidade hospitalar interagiram de maneira complexa durante a pandemia, verificou-se uma associação positiva entre cirurgias de fraturas da anca nas 48h e eficiência técnica hospitalar; iv) verificou-se uma relação positiva entre o número de médicos e a eficiência técnica; e v) o modelo organizacional dos Centros Hospitalares teve uma menor heterogeneidade nos scores de eficiência técnica em relação ao modelo hospitalar, e modelo de gestão EPE, durante o período pandémico, a eficiência foi estável. Como principais conclusões foi que se verificou que durante a pandemia, a eficiência técnica das unidades hospitalares não variou, significativamente, em relação ao período pré-pandémico. As principais estratégias para manter a produção hospitalar foram a realocação de espaços físicos, o uso da telemedicina, o alargamento de horários e colaboração com entidades externas. Verificou-se que a qualidade dos cuidados hospitalares teve influência na eficiência, existindo uma associação entre cirurgias de fraturas da anca e eficiência. Em relação aos recursos humanos verificou-se que durante a pandemia, houve um aumento no número de médicos, enfermeiros e camas hospitalares a nível nacional, estes recursos seguiram um padrão de concentração em áreas urbanas. As unidades hospitalares com maior eficiência técnica situaram-se, predominantemente, na zona norte, o que refletiu uma maior resiliência desses hospitais. Verificou-se uma relação positiva entre o número de médicos e a eficiência técnica, sendo que o aumento do número de médicos está associado a um aumento da eficiência das unidades hospitalares. E por último, confirmou que o modelo de organização dos hospitais influenciou o desempenho das unidades hospitalares, durante o período de pandemia. O modelo organizacional dos Centros Hospitalares teve uma menor heterogeneidade nos scores de eficiência técnica em relação ao modelo hospitalar, sugerindo que a estrutura dos centros hospitalares promove mais consistência na eficiência. Em relação ao modelo de gestão EPE conclui-se que durante o período pandémico, a eficiência foi estável, existindo uma ligeira redução das unidades ineficientes.
In March 2020, Portugal, like the rest of the world, faced the challenge of a pandemic. In the response to the pandemic, hospital care has been at the epicentre. In most of the countries and regions affected by COVID-19, hospital units have reached their maximum capacity, which, coupled with a severe shortage of human resources, has posed an unprecedented challenge to hospital management. The pandemic had a strong impact on hospital production in the SNS, with a reduction in hospital activity. Due to the highly complex and uncertain context resulting from the COVID-19 pandemic, the areas of access, efficiency and quality of hospital care have come under the spotlight. The main objective of this study was to verify the effect of the COVID-19 pandemic on the management performance of NHS hospitals. In order to gain a deeper understanding of the effects of the pandemic, an analysis was carried out of its impact on technical efficiency results in the different organisational and management models of hospital units, as well as the strategies adopted to deal with the pandemic. Finally, we analysed the influence of the quality of hospital care and the availability of resources on efficiency results. The sample of this study consisted of 32 hospital units, 31 of which were EPE (21 Hospital Centres and 11 single Hospitals) and one PPP. Methodologically, the quantitative component of the study used the Data Envelopment Analysis technique to determine the technical efficiency results, and the Sperman correlation and Multiple Linear Regression to verify the effect of the quality of hospital care on efficiency. Tobit regression was used to verify the effects of the availability of resources on efficiency results. The qualitative component of the study used semi-structured interviews, analysed using content analysis to assess the interviewees' perceptions of the factors that influenced efficiency and quality of care and the strategies adopted during the pandemic. The main results were that: i) in the first year of the pandemic, the technical efficiency score of hospital units varied between 0.475 and 1.205, and in the second year the variation was between 0.508 and 1.219. There were no significant differences in average technical efficiency between the pre-pandemic period (0.840) and the pandemic period (0.847); ii) the main strategies for maintaining hospital production were the reallocation of physical spaces, the use of telemedicine, extending opening hours and collaborating with external organisations, such as private and military organisations to increase response capacity; iii) hospital quality indicators interacted in a complex way during the pandemic, there was a positive association between hip fracture surgeries within 48 hours and hospital technical efficiency; iv) there was a positive relationship between the number of doctors and technical efficiency; and v) the organisational model of Hospital Centres had less heterogeneity in technical efficiency scores compared to the hospital model, and the EPE management model, during the pandemic period, efficiency was stable. The main conclusions were that during the pandemic, the technical efficiency of hospital units did not vary significantly compared to the pre-pandemic period. The main strategies to maintain hospital production were the relocation of physical spaces, the use of telemedicine, the extension of opening hours and collaboration with external organisations. The quality of hospital care was found to influence efficiency, and there was an association between hip fracture surgery and efficiency. In terms of human resources, there has been an increase in the number of doctors, nurses and hospital beds nationwide during the pandemic, and these resources have followed a pattern of being concentrated in urban areas. The hospital units with the highest technical efficiency were predominantly located in the north, reflecting the greater resilience of these hospitals. There was a positive relationship between the number of doctors and technical efficiency, with an increase in the number of doctors being associated with an increase in the efficiency of hospital units. Finally, it confirmed that the organisational model of hospitals influenced the performance of hospital units during the pandemic. The organisational model of the Hospital Centres had less heterogeneity in the technical efficiency scores compared to the hospital model, suggesting that the structure of the hospital centres promotes more consistency in efficiency. With regard to the EPE management model, it can be concluded that efficiency was stable during the pandemic period, with a slight reduction in inefficient units.
In March 2020, Portugal, like the rest of the world, faced the challenge of a pandemic. In the response to the pandemic, hospital care has been at the epicentre. In most of the countries and regions affected by COVID-19, hospital units have reached their maximum capacity, which, coupled with a severe shortage of human resources, has posed an unprecedented challenge to hospital management. The pandemic had a strong impact on hospital production in the SNS, with a reduction in hospital activity. Due to the highly complex and uncertain context resulting from the COVID-19 pandemic, the areas of access, efficiency and quality of hospital care have come under the spotlight. The main objective of this study was to verify the effect of the COVID-19 pandemic on the management performance of NHS hospitals. In order to gain a deeper understanding of the effects of the pandemic, an analysis was carried out of its impact on technical efficiency results in the different organisational and management models of hospital units, as well as the strategies adopted to deal with the pandemic. Finally, we analysed the influence of the quality of hospital care and the availability of resources on efficiency results. The sample of this study consisted of 32 hospital units, 31 of which were EPE (21 Hospital Centres and 11 single Hospitals) and one PPP. Methodologically, the quantitative component of the study used the Data Envelopment Analysis technique to determine the technical efficiency results, and the Sperman correlation and Multiple Linear Regression to verify the effect of the quality of hospital care on efficiency. Tobit regression was used to verify the effects of the availability of resources on efficiency results. The qualitative component of the study used semi-structured interviews, analysed using content analysis to assess the interviewees' perceptions of the factors that influenced efficiency and quality of care and the strategies adopted during the pandemic. The main results were that: i) in the first year of the pandemic, the technical efficiency score of hospital units varied between 0.475 and 1.205, and in the second year the variation was between 0.508 and 1.219. There were no significant differences in average technical efficiency between the pre-pandemic period (0.840) and the pandemic period (0.847); ii) the main strategies for maintaining hospital production were the reallocation of physical spaces, the use of telemedicine, extending opening hours and collaborating with external organisations, such as private and military organisations to increase response capacity; iii) hospital quality indicators interacted in a complex way during the pandemic, there was a positive association between hip fracture surgeries within 48 hours and hospital technical efficiency; iv) there was a positive relationship between the number of doctors and technical efficiency; and v) the organisational model of Hospital Centres had less heterogeneity in technical efficiency scores compared to the hospital model, and the EPE management model, during the pandemic period, efficiency was stable. The main conclusions were that during the pandemic, the technical efficiency of hospital units did not vary significantly compared to the pre-pandemic period. The main strategies to maintain hospital production were the relocation of physical spaces, the use of telemedicine, the extension of opening hours and collaboration with external organisations. The quality of hospital care was found to influence efficiency, and there was an association between hip fracture surgery and efficiency. In terms of human resources, there has been an increase in the number of doctors, nurses and hospital beds nationwide during the pandemic, and these resources have followed a pattern of being concentrated in urban areas. The hospital units with the highest technical efficiency were predominantly located in the north, reflecting the greater resilience of these hospitals. There was a positive relationship between the number of doctors and technical efficiency, with an increase in the number of doctors being associated with an increase in the efficiency of hospital units. Finally, it confirmed that the organisational model of hospitals influenced the performance of hospital units during the pandemic. The organisational model of the Hospital Centres had less heterogeneity in the technical efficiency scores compared to the hospital model, suggesting that the structure of the hospital centres promotes more consistency in efficiency. With regard to the EPE management model, it can be concluded that efficiency was stable during the pandemic period, with a slight reduction in inefficient units.
Description
Keywords
Pandemia Gestão Eficiência Técnica Unidades Hospitalares Qualidade Pandemic Management Technical Efficiency