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Abstract(s)
O envelhecimento da população portuguesa, grande carga de doenças crónicas
não transmissíveis e restrições orçamentais são apenas alguns dos desafios que os
Cuidados de Saúde Primários do Serviço Nacional de Saúde português enfrentam e que
se irão agravar nas próximas décadas. Pretendendo contribuir para a superação destes,
esta dissertação analisou o funcionamento da Consulta Aberta da Unidade de Saúde
Familiar USF da Estrela à luz da metodologia Lean Healthcare, que representa a
aplicação da metodologia Lean Management ao setor da saúde, com o objetivo de sugerir
melhorias ao funcionamento desta.
Após uma breve pesquisa bibliográfica sobre Lean Healthcare, foram
contactadas diversas unidades funcionais. A USF da Estrela, demonstrando interesse
nesta investigação, sugeriu a análise da sua Consulta Aberta. Seguindo os 5 princípios de
Lean Healthcare, começou-se pela determinação das características que atribuem valor
à Consulta Aberta através da análise dos critérios utilizados nas avaliações externas do
desempenho da USF da Estrela e da análise estatística da distribuição horária e diária
dos Questionários da Consulta Não Programada. De seguida, para a determinação da
cadeia de valor, otimização de fluxos e implementação dum sistema pull, foram
realizados estágios observacionais, entrevistas semi-dirigidas e criados diagramas
representativos do funcionamento desta consulta entre outubro e dezembro de 2022 e
daquilo que, à luz do Lean Healthcare, representaria o seu ideal funcionamento. Por fim,
foram analisados os mecanismos de melhoria contínua que abrangem esta unidade.
Esta dissertação encontrou, o que segundo Lean Healthcare se consideram,
desperdícios, sugerindo, para a sua eliminação, a supressão da escolha entre Consulta
Aberta e Consulta de Intersubstituição Não Programada, a confirmação dos dados do
utente através de confirmação visual e a eliminação do Questionário da Consulta Não
Programada. É também sugerida a impressão de documentos Just In Time, digitalização
das comunicações internas e o ajuste dinâmico do horário reservado para Consultas Não
Programadas com base no perfil com que esta é procurada.
Os benefícios que os resultados promissores desta dissertação podem trazer, a
nível de desperdícios identificados e formas de os eliminar, carecem de confirmação
através da investigação da aplicação dos mesmos à Consulta Aberta da USF da Estrela.
No entanto, estes reforçam a importância da investigação da aplicação desta metodologia
aos serviços e unidades dos cuidados de saúde primários portugueses pelo seu potencial
em guiar os trabalhadores destes cuidados, e do Serviço Nacional de Saúde português em
geral, nos seus processos de melhoria continua.
The aging of the Portuguese population, the increasing burden of noncommunicable chronic diseases, and budgetary constraints are just a few of the challenges that the Primary Health Care services of the Portuguese National Health Service will have to face in the coming decades. With the aim of contributing to overcoming these challenges, this dissertation analyzes the Open Access Consultation of the Family Health Unit USF da Estrela, through the lens of the Lean Healthcare methodology, which represents the application of Lean Management methodology in the healthcare sector, with the goal of providing suggestions to improve it. After a brief literature review of Lean Healthcare, several functional units were contacted. Family Health Unit, USF da Estrela, showed interest in this study and suggested the analysis of its Open Access Consultation. USF da Estrela’s Open Access Consultation, referred to as “Consulta Aberta” by USF da Estrela, was analyzed according to the 5 principles of Lean Healthcare, starting with the determination of what brings value to it. For this, the investigator analyzed the criteria used in external evaluations of USF da Estrela’s performance, and determined through statistical analysis the hourly and daily frequency with which the Unplanned Consultation Questionnaires were delivered by the patients. In order to determine the value chain, optimize flows, and implement a pull system, the investigator visited USF da Estrela several times, during which semi-directed interviews were conducted. In addition, diagrams were created to represent USF da Estrela’s Open Access Consultation process for delivering care, as well as what, according to Lean Healthcare, should be its ideal process. Finally, the mechanisms used for continuous improvement of USF da Estrela, were analyzed. This dissertation identified, what according to Lean Healthcare should be considered, waste and, to eliminate it, suggested suppressing the choice between Open Access Consultation and Unplanned Interchange Consultation, a visual process for confirmation of the patient’s identifiable number, and the elimination of the Unplanned Consultation Questionnaire. Suggestions also included the adoption of a Just-In-Time printing strategy, digitalization of internal communication, and dynamically adjusting the allocation of reserved time slots for Unplanned Consultations according to demand. The promising results of this dissertation, namely the identified waste and ways to eliminate it, underline the importance of investigating its application at USF’s da Estrela’s Open Access Consultation, as well as strengthen the case for investigating the application of this methodology to other Portuguese primary health care units and services, further contributing to overcoming the existent and future challenges the primary care services in Portugal will face.
The aging of the Portuguese population, the increasing burden of noncommunicable chronic diseases, and budgetary constraints are just a few of the challenges that the Primary Health Care services of the Portuguese National Health Service will have to face in the coming decades. With the aim of contributing to overcoming these challenges, this dissertation analyzes the Open Access Consultation of the Family Health Unit USF da Estrela, through the lens of the Lean Healthcare methodology, which represents the application of Lean Management methodology in the healthcare sector, with the goal of providing suggestions to improve it. After a brief literature review of Lean Healthcare, several functional units were contacted. Family Health Unit, USF da Estrela, showed interest in this study and suggested the analysis of its Open Access Consultation. USF da Estrela’s Open Access Consultation, referred to as “Consulta Aberta” by USF da Estrela, was analyzed according to the 5 principles of Lean Healthcare, starting with the determination of what brings value to it. For this, the investigator analyzed the criteria used in external evaluations of USF da Estrela’s performance, and determined through statistical analysis the hourly and daily frequency with which the Unplanned Consultation Questionnaires were delivered by the patients. In order to determine the value chain, optimize flows, and implement a pull system, the investigator visited USF da Estrela several times, during which semi-directed interviews were conducted. In addition, diagrams were created to represent USF da Estrela’s Open Access Consultation process for delivering care, as well as what, according to Lean Healthcare, should be its ideal process. Finally, the mechanisms used for continuous improvement of USF da Estrela, were analyzed. This dissertation identified, what according to Lean Healthcare should be considered, waste and, to eliminate it, suggested suppressing the choice between Open Access Consultation and Unplanned Interchange Consultation, a visual process for confirmation of the patient’s identifiable number, and the elimination of the Unplanned Consultation Questionnaire. Suggestions also included the adoption of a Just-In-Time printing strategy, digitalization of internal communication, and dynamically adjusting the allocation of reserved time slots for Unplanned Consultations according to demand. The promising results of this dissertation, namely the identified waste and ways to eliminate it, underline the importance of investigating its application at USF’s da Estrela’s Open Access Consultation, as well as strengthen the case for investigating the application of this methodology to other Portuguese primary health care units and services, further contributing to overcoming the existent and future challenges the primary care services in Portugal will face.
Description
Keywords
Melhoria Contínua Consulta Aberta Cuidados de Saúde Primários Lean Healthcare Lean Management