Dinâmica de inovação em diferentes modelos de gestão hospitalar

Abstract

The characteristic pressures of the health sector have a considerable impact on hospitals in view of the complexity, dynamics and rapid technological and epidemiological changes, involving the production and supply of health services. The adoption of different hospital management models highlights Bahia's effort to provide alternatives in the face of pressures faced by hospital services. The objective of this sequential mixed methods study was to analyze the dynamics of innovation, involving the relationship between determining factors impacting on innovation performance in hospitals, managed by the three types of management models: Direct Public Administration (APD), Social Health Organizations (OSS) and Public-Private Partnership (PPP). The first phase, of a quantitative nature, validated a theoretical model to measure, confirm or refute hypotheses of the relationship between the determining factors with innovation performance. Once the factors with the greatest impact were confirmed, these were explored in depth in the second qualitative phase, aiming to detail the organizational dynamics, in order to drive innovations that would enable better conditions for hospitals to react to the pressures of the health sector. In the quantitative phase, confirmatory factor analysis, multigroup analysis of invariance and structural equation modeling were used and, in the qualitative phase, text mining and open, axial and selective coding techniques were used. The units of analysis were in three hospitals, each representing a management model, linked to assistance, teaching, research and extension activities, carried out in partnerships with faculties, research institutes and the Hospital Management Innovation and Learning Network (InovarH ) as well as the reference in specialized areas of health, with bed capacity and located in Salvador/BA. The validation of the proposed theoretical model proved to be adequate for application in this research and the measurement of determining factors. Based on this model, the following were confirmed as having the greatest impact on innovation performance: strategic leadership, strategic intention to innovate, people management for innovation and strategic technology management. The detail of the organizational dynamics evidences the influence of the determining factors confirmed in the quantitative phase, represented in the categories of managers, employees, innovation, change, process and technology, as well as, emerging from the analysis of the qualitative phase, categories that interacted with these factors such as: implementation, organizational image and care structure, with the support of technologies that drive innovation in services and processes, through the subcategories, respectively, new and reformulated services and improvement of operations. These innovated services enable better conditions for hospitals, in order to positively impact the network/regulation, patient and hospital categories. Significant differences stand out in the relationships between the factors of the strategic intention to innovate with transforming leadership and this with the management of people for innovation and interact with other categories evidenced in a differentiated way between the management models in obtaining the technologies. The results showed a dynamic of innovation in the different models of hospital management, impacting the performance in innovation, which allow better conditions to react to the pressures of the health sector.